TRAINING - ATLANTA, GEORGIA - November 14, 2017

Sponsored by Alston & Bird, The State Bar of Georgia & Troutman Sanders

* Location:  


 1. Name
         * First Name:
         * Last Name:
            Middle Initial:

         * Salutation:

 2. Contact Information
        * Company:
        * Address:
          Address 2:
        * City/Town:

        * State:

        * Zip/Postal Code:
        * Email Address:
          Email Address 2:
 3. Telephone/Fax
          Work (Direct Line):     Ext.
          Work (Main Line):
          Work Fax:
          Personal Fax:
          Preferred Phone:
  Is there an alternate address you would like to provide?
 4. Alternate Address
          Alt. Company:
          Alt. Address:
          Alt. Address 2:
          Alt. City:

          Alt. State:

          Alt. Zip:
          Alt. Address Type:
          Preferred Address:
 5. Size of Organization/Firm
      Individual - Solo
      2-5 Lawyers
      6-10 Lawyers
      11-20 Lawyers
      21-50 Lawyers
      51-100 Lawyers
      101+ Lawyers
 6. How did you find out about the Veterans Pro Bono Program?
 7. Organization's/Firm's Pro-Bono Coordinator (if any):
                   First Name:
                   Last Name:
 8. Law school attended?
 9. Year of Graduation from law school? (write in None if not graduated law school)
 10. Main areas of practice (check all that apply).
        Administrative Law
        Anti Trust
        Appellate Litigation
        U.S. Ct. of Appeals for Veterans Claims
        Consumer Law
        Contract law
        Corporate Law
        Criminal Law
        Elder law
        Employment Discrimination
        General Practitioner
        Health Care Law
        Intellectual Property
        International Law
        Military law
        Labor law
        Legal Services
        Maritime Law
        Patent Law
        Qui Tam
        Real Estate
        Tax Law
        Veterans Benefits Law
Other (please specify)
*11. Are you a veteran?
 12. If a Veteran, In which branch of the United States Military did you serve?
        Air Force
        Coast Guard
Other (please specify)
*13. Are you VA Accredited? (note: VA accreditation is not required to participate in this program)
*14. Have you handled a VA Claims Case?
*15. Have you handled a military discharge upgrade case?
*16. Have you handled a case before the Court of Appeals for Veterans Claims?
*17. Have you previously handled an appellate case?
*18. State in which you are Licensed (NA if not licensed)
 19. Bar Number (if your state does not issue bar numbers, enter NA)
 20. If you are licensed in more than one state or have never been licensed in a state
        other than the one listed above, place the information int he box below.
 21. Language(s) Spoken:
Other (please specify)
 22. Any Additional Comments?
  The Next Three Questions are Optional.

  The Veterans Consortium Pro Bono program requests demographic information
  from attorneys who volunteer for our Program. Any information that we collect
  is compiled for statistical purposes only in response to requirements of our
  federal grant. Your answers are optional. There is no penalty for declining
  to provide this information.
 23. Gender
 24. Ethnic Background
        Caucasian (white: non-Hispanic origin)
        Black (non-Hispanic origin)
        Hispanic Origin
        Native American
        Asian/Pacific Islander
        Other/Mixed Race
 25. In what year were you born?
 26. If t-shirts were provided, what size would you prefer?
        Extra Large
        2 XL
        3 XL


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