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Attorney Profile

Please provide the following information for our files. If more than one attorney from your firm will participate or, if you have more than one office, please complete a profile for each attorney and/or office.

Kindly attach a piece of your office letterhead, business card(s) and copy of your malpractice insurance binder to this profile. If you have completed your profile online, please submit the original via mail.

FIRM NAME:
ATTORNEY NAME:
BAR #:
CONTACT PERSON:
ADDRESS:
CITY:
STATE:     ZIP:
TELEPHONE:
FAX:
E-MAIL ADDRESS:
WEB SITE:

Would you be interested in participating in public relations opportunities, submitting written articles for publications or do public speaking at benefit enrollment seminars?
Yes No

Total years of experience:

Number of attorneys in firm:

List geographic locations or counties to which you are willing to travel to assist clients:

Do you maintain professional liability insurance?
Yes No

Do you wish to participate in the Individual / Family Plan Referral Network?
Yes No

Do you wish to participate in the Small Business Plan Referral Network?
Yes No

COMPLETED BY: DATE:
ATTORNEY SIGNATURE:

Please check the appropriate boxes to indicate the areas of law that your firm practices:

Administrative Law
Adoption
Agricultural Law
Aviation Law
Business Law
Civil Rights
Commercial Motor Vehicle
Condominium Law
Construction Law
Copyright / Trademark
Corporate Law
Criminal Felony
Custody Issues
Divorce (Simple)
DUI/DWI
Entertainment Law
Environmental Law
Foreclosure
Fraud
General Practice
Human Rights
Incompetence / Infirmity
International Law
Juvenile Court Proceedings
Legal Malpractice
Loan Modification
Maritime
Medical Malpractice
Mobile Home Law
Paternity
Product’s Liability
Social Security
Support (spouse or child)
Tax / Financial Matters
Wills, Probate, Estates, Trusts
ADA Issues
Admiralty (Maritime)
Appellate
Antitrust Law
Bankruptcy
Civil Litigation
Collections
Computer Law
Contract Law
Consumer Protection
Criminal Misdemeanor Defense
Credit repair
Debt Settlement
Divorce (Contested)
Domestic Partner Issues
Elder Law
Entertainment / Sports
Felony Defense
Guardianship
Health Care Law
Immigration / Naturalization
Insurance Law
Labor & Employment
Landlord / Tenant
Local Government Law
Military Law
Personal Injury
Patent Law
Securities Law
Real Estate
Sports Law
Tribal Law
Traffic Ticket Defense
Worker’s Compensation

Please list other areas of practice not listed above:

Comments of other pertinent information
(Additional office locations, foreign language capability, etc.):

PLEASE RETURN COMPLETED PROFILE TO:

Legal Club of America®
Attn: Provider Services Department
7771 West Oakland Park Boulevard, Suite 217
Sunrise, FL 33351
Facsimile: (954) 267-0401