Membership Form - THE CAPITAL DISTRICT WOMEN'S BAR ASSOCIATION

First Name *

Last Name *

If you have previously been a member under a different name, please indicate that name below.

Firm or Business Affiliation *

Address 1 *

Address 2

City / Town *

State *

Zip Code *

County *

Please indicate if this address is a business or home address. *

BusinessHome

Business Phone

Cell Phone

Email *

Birthday MM/DD

Year of NYS Admission MM/DD/YYYY

Law School and Year of Degree School Name, MM/YYYY

NYS Attorney Registration Number

Membership Options *

$150 Sustaining Member$125 Member admitted over 10 years$100 Member admitted 3-10 years$75 Member admitted less than 3 years$75 Class I Retiree (must be age 60 or older, certify as retired with OCA and no longer engaged in the paid practice of law)$50 Non-Attorney Affiliate (Note: WBASNY bylaws do not provide for non-attorney memberships, but this affiliate status provides all member benefits and discounts except eligibility to participate in membership votes or run for elected positions within the organization)$25 Member through another WBASNY chapter$25 Law student or graduate awaiting admission to the NYS Bar

Areas of Concentration *

Areas of Concentration

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