Member Credit Request Form - The State Bar Of California
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1
2For Office Use Only
MEMBER CREDIT REQUEST
Minimum Continuing Legal Education
$25
No check
The State Bar of California
Other
Member Services Center
Appl. #: _____________________
180 Howard Street
San Francisco, CA 94105-1639
Prov. #: _____________________
888-800-3400
A $25 nonrefundable fee must accompany each activity and each application. Attach promotional materials, if
available. Consideration of your application can take up to 60 days. All applications must be submitted at least
st
60 days prior to the February 1
deadline for your compliance group in order to be considered for that
compliance period.
IS THIS ACTIVITY APPROVED FOR CLE CREDIT IN ANY OTHER STATE?
Yes
No
If yes, you may not need to submit this application. You may claim credit from an “Approved Jurisdiction” if you attended an
activity outside California and it is NOT transferred electronically to California, offered for downloading or viewing on the
Internet, or for sale as a tape, CD, DVD, document(s), or any other acceptable format
AND if the activity you attended is approved for MCLE credit (including any subfield credit) by an “Approved Jurisdiction.”
(For a list of approved jurisdictions please go to our Web site
and click on the following links: mcle >
attorney information > approved jurisdictions.)
MEMBER INFORMATION
_________________________________________________________________________________
MEMBER NAME:
STATE BAR MEMBER NUMBER:________________________
ADDRESS: ______________________________________________________________________________________________
CITY: ______________________________________________________ STATE: ____________ ZIP: _____________________
PHONE NO. (
)__________________________________ FAX NO. (
)_____________________________________
ACTIVITY INFORMATION
TITLE: ___________________________________________________________________________________________________
DATE: ___________________________________
SITE OF ACTIVITY:
CITY: ______________________________________________________ STATE: ____________ ZIP: ______________________
COUNTRY: _______________________________
PROVIDER INFORMATION
NAME: ___________________________________________________________________________________________________
ADDRESS: _______________________________________________________________________________________________
CITY: ______________________________________________________ STATE: ____________ ZIP: ______________________
(
)_______________________________
PHONE NO:
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