Attorney Registration

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UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
ATTORNEY REGISTRATION
TO BE COMPLETED ONLY IF YOU WERE
PREVIOUSLY ADMITTED TO THE FOURTH CIRCUIT BAR
NAME (present practicing name)
Last _____________________________________________________________________________________
First ____________________________________ Middle _________________________________________
Generation (Jr.,Sr.,II,etc.) ___________ Title (if applicable) _______________________________________
Prefix (Mr.,Ms.,Professor,etc.) ________________________________________________________________
FIRM: ___________________________________________________________________________________
ADDRESS: _______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
City
____________________________________________________________________________________
State _________________________
Zip Code ____________________________
Phone (____)___________________
Ext. __________
Fax (____)___________________________
E-mail
____________________________________________________________________________________________
YEAR OF BIRTH: _______
APPROXIMATE DATE ADMITTED TO U.S. COURT OF APPEALS FOR THE FOURTH CIRCUIT
__________________________________________________________________________________________
STATE OF RESIDENCE ____________________________________________________________________
IF ADMITTED UNDER A DIFFERENT NAME, PROVIDE NAME UNDER WHICH YOU WERE
ADMITTED _______________________________________________________________________________
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SCC
10/03/2011

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