Military Assistance Panel Program Registration Form Oregon Page 2
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1
2Military Assistance Panel
Program Registration
Oregon State Bar Referral & Information Services
PO Box 231935, Tigard, OR 97281-1935
Voice: (503) 431-6408 or (800) 452-8260 ext. 408
Fax: (503) 431-6444 or Email:
In addition to advising on the Servicemembers' Civil Relief Act,
please check the referral categories under each panel for which you would like to receive referrals. Complete
the signature and acknowledgment section, and return this form to the OSB.
Substantive Law Referral Categories
Taxation
Bankruptcy
o
o
Estate Planning
Consumer
o
o
Immigration
Criminal Law
o
o
Landlord/Tenant
Family
o
o
Other ________________________
Labor & Employment
o
o
Real Property
o
Servicemembers' Civil Relief Act training
A number of training options are available through the Oregon State Bar and the American
Bar Association. Upon receipt of your completed registration form, we will e-mail a link to
you that explains these training options.
Signature and Acknowledgment
I am an active member of the Oregon State Bar in good standing and am not the subject of a formal
disciplinary proceeding. I have also completed (or will complete prior to accepting referrals) CLE
training on the Servicemembers' Civil Relief Act. Please select one of the following:
I maintain malpractice coverage with the Professional Liability Fund.
o
I do not currently carry coverage with the Professional Liability Fund but will
o
participate in the Military Assistance Panel Program through the special policy
for OSB Certified Pro Bono Programs.
Signature _________________________________________________ Date_______________
(Print Name) ______________________________________________ Bar #
Address ______________________________________________________________________
City/State/Zip ______________________________________ Phone _____________________
Fax ________________________ Email ____________________________________________
I prefer to receive notices by
o email
o fax
Return Form to:
MAIL: OSB Military Assistance Panel
FAX: 503.431.6444
Attn: RIS
PO Box 231935
Tigard, OR 97281-1935
06/2015
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