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Criminal Referal Panel Application

Broward County Bar Association's

Low Cost Referral Program

Co-sponsored by Broward Association of Criminal Defense Lawyers
and
Legal Aid Service of Broward County, Inc.

Please fill in the information below:

Name:
Firm/Office:
Address:
Mailing Address (if different):
City:
State:
Zip:
Phone:
Fax:
Email:
Date of Birth:
Florida Bar #:
Date admitted to Florida Bar:
Name of Law School:
Other Degrees Earned:
I would like to participate in the Broward County Bar Association’s Low Cost Criminal Referral Program.
I understand that in order to join the Low Cost panel, I must become a dues-paying member of the Broward County Bar Association. Once I become a BCBA member, I am aware there is no additional charge to join the Low Cost Criminal Referral Panel.
Enclosed is my BCBA annual dues payment and membership application.
I also wish to join the regular Referral Program of the Broward County Bar Association to be able to accept clients other than ‘low cost’ clients. Please send me a separate regular Referral Program application.