Panel Attorney Application

Full Name:*


Email:*


Phone Number:*


Office Address:

Firm Name (If applicable):


Address:*


City:*


State:*


Zip:*


Home Address:

Address:*


City:*


State:*


Zip:*


Year admitted to Bar:





I would like to volunteer for the following MdVLA activities:

Accepting referrals of clients for pro bono services

Participating in arts and entertainment law workshops and seminars

Please indicate your areas of expertise by entering the number of years of experience that you have in each area of law:

Art

Copyright

Trademark

Patent

Trade Secrets

First Amendment (e.g., Censorship/Obscenity)

Bankruptcy

Broadcasting

Commercial

Corporate

Non-Profit Entity Formation

Employment

Entertainment

Immigration

Insurance

Internet

Litigation

Criminal

Real Estate

Tax

Trusts and Estates

Other: (Please Specify)




If you indicated that you have experience in Entertainment Law, Art or Internet Law, please specify the areas of the industry in which you have experience and your level of experience:

Artist-Gallery

Art Prints

Licensing and Commissions

Book Publishing

Television (describe)

Film (describe)

Actors

Music Recording

Music Publishing

Theater (describe)

Photography

Rights Clearance

Other


If you want to take a case in a area you have not worked in, and would be willing to work with an attorney experienced in that area, please check here.


If there are any areas of law in which you DO NOT want to receive referrals, please identify:




If you have volunteered to accept pro bono referrals, please complete the following:

Have you been convicted of a felony or do you presently have any felony charges pending against you? If yes, please provide details.



Have you previously been subject to any disciplinary proceedings by the bar of any state or do you presently have any disciplinary proceedings pending against you? If yes, please provide details.




MdVLA will do its best to match you with prospective pro bono clients that are in your general geographic area but, due to the nature of the pro bono clients, some may not have the ability to travel to your office and may require you to travel to meet with them. MdVLA requires that you personally interview all pro bono clients that are assigned to you. If you are unwilling to travel more than twenty-five miles away from your office to meet with a pro bono client, please indicate by checking this box.


If you are currently covered by a professional malpractice insurance policy, please provide the information relevant to your policy below. In the event that your coverage is cancelled or changed or any relevant information relating to your policy changes, you will promptly notify MdVLA of such cancellation or change.

Name:


Address:


City:


State:


Zip:


Insurance Agent:

Insurance Agent Telephone Number:

Policy Number:

Expiration Date:



I have read this application and I certify that the information provided by me is true and accurate to the best of my knowledge.
Type your name and todays date:

MdVLA panel attorneys are required to remit a $35 tax-deductible contribution with this application.
All information provided herein shall remain confidential and shall be held in confidence by MdVLA, to be used solely for MdVLA business. Your contact information may be provided to prospective pro bono clients but shall not be provided to any third parties without your consent.

Please provide a current resume via email to info@mdvla.org after submission of this application. Your application will not be complete until your current resume is received by MdVLA.

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