Mentee Sign Up Form | Broward Bar

Personal Information

Name

FirstLast

Gender

Firm/Employer/Law School

Address

Street AddressCityStateZip Code

Business Phone

Mobile Phone

Email

How do you prefer to be contacted by your Mentor?

Are you a member of the BCBA?

(Please submit BCBA membership application if eligible)

Are you a member in Good Standing of The Florida Bar?

Florida Bar Number

Are you a member in Good Standing in any other jurisdiction?

Where do you practice (if different from your address)?

How did you learn about the program?

Practice Areas for Mentoring:

Years in Practice

Law School Grad Year

I would like to be mentored in the following skills

Waiver and Release*

By checking this box I acknowledge that I will complete the PDF listed below and either fax, mail, or email it to Art Goldberg at the BCBA.