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UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT ATTORNEY REGISTRATION TO BE COMPLETED ONLY IF YOU WERE PREVIOUSLYADMITTED TO THE FOURTH CIRCUIT BAR

NAME (present practicing name) Last _____________________________________________________________________________________ First ____________________________________ Middle _________________________________________ Generation (Jr.,Sr.,II,etc.) ___________ Title (if applicable) _______________________________________ Prefix (Mr.,Ms.,Professor,etc.) ________________________________________________________________

FIRM: ___________________________________________________________________________________ ADDRESS: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ City ____________________________________________________________________________________ Zip Code ____________________________ Ext. __________
Fax (____)___________________________

State _________________________ Phone (____)___________________
E-mail

DATE OF BIRTH: _________________________________________________________________________

APPROXIMATE DATE ADMITTED TO U.S. COURT OF APPEALS FOR THE FOURTH CIRCUIT __________________________________________________________________________________________ STATE OF RESIDENCE ____________________________________________________________________ IF ADMITTED UNDER A DIFFERENT NAME, PROVIDE NAME UNDER WHICH YOU WERE ADMITTED _______________________________________________________________________________