Dallas Gay and Lesbian Bar Association 2015 Membership Form

Dallas Gay and Lesbian Bar Association 2015 Membership Form
You do not need to be a member of the Dallas Bar Association to be a member of the DGLBA.
Name: _______________________________ Firm/Organization:_______________________________
E-mail Address: _______________________________________________________________________
Website: _____________________________________________________________________________
Telephone: ___________________________________________________________________________
Mailing Address: ______________________________________________________________________
Membership Levels:
$35 Attorney or other non-attorney professional
$25 Judge, Court Staff, Government Employee, or non-profit employee
$20 Law student, non-licensed attorney, and paraprofessionals
I would like for my information to be published on www.dglba.org and www.dglba.com under the practice areas
selected below. Please add $10 to your dues for each practice area you would like to be listed under on the
website. Please check, X, or make other visible markings for the preferred areas you wish to be listed:
o Appellate Law
o Entertainment Law
o Other – Non-Attorney
o Auto/Car Crash
o Family Law
o Patent, Trademark, and
o Bankruptcy
o Immigration
Copyright Law
o Collaborative Law
o Intellectual Property
o Personal Injury
o Corporate Law
o Labor and Employment
o Probate
o Criminal Defense
o Litigation
o Real Estate
o Disability
o Media & Internet Law
o Slip and Falls
o Estate Planning
o Medical Malpractice
I would like to help with or learn more about:
Presenting a CLE program at one of our monthly meetings.
Hosting or helping with a networking and/or social event.
Please make checks payable to DGLBA and mail to:
DGLBA c/o Aaron Parrish, 7616 LBJ Freeway, Suite 401, Dallas, Texas 75251
If you are paying with a credit card, you may return your completed form via email to dglba2012@gmail.com.
PAYMENT METHOD:
Amex
Visa
MasterCard
Discover
Check
Card Number:
Amount Paid: $ _____
________________________
Signature
Expires:
||
CVV:
Billing Address if different from above: _____________________
_____________________
_________________________
Cardholder Name (please print)