Free Document - Louisiana

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF LOUISIANA ATTORNEY REGISTRATION STATEMENT Pursuant to Rule VII(D) of the Rules of Disciplinary Enforcement of the United States District Court for the Eastern District of Louisiana TITLE Mr. ___ NAME Mrs. ____ Miss __ Ms. ____ LA Bar No. _________

__________________________________________________ (Last) (First) (Middle)

FIRM NAME ______________________________________________ OFFICE ADDRESS RESIDENCE ADDRESS ___________________________________ ___________________________________ __________________________________ ___________________________________ BUSINESS TELEPHONE NUMBER FAX NUMBER _____________________ ___________________________________

List below the Bars of all states, territories, districts, commonwealths or possessions or other courts of the United States to which you are admitted to and the dates of such admissions: Bars Dates

_____________________________________________________________ _____________________________________________________________ _____________________________________________________________ ________________ Date _____________________________ Signature

NOTE: A Supplemental statement of any changes in the foregoing information shall be filed within 30 days of such change. Rev 5/97