Membership Application Form

Membership Application Form
Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Name and Address*
Professional Title*
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Law School/Graduation Year
YesNo
Year Admitted and Bar Admissions - list all jurisdictions
YesNo
Letter of Intent

Cancelof
Areas of Practice/Interest*
YesNo
Attorney Referral CommitteeCLE CommitteeEmployment CommitteeJudicial Screening CommitteeLaw Students CommitteeMembership CommitteeNominating CommitteePublic Relations CommitteeSocial Justice Committee
YesNo
YesNo
If a Judicial Member, year elected or appointed:
Student - $0.00Non-Lawyers (except students) - $50.00Newly Admitted Attorney (5 years or less) - $50.00Private Sector Attorney (over 5 years) - $100.00Public Service Attorney - $100.00Judiciary - $100.00Hardship Exemption Request
Contact us via email at Hudsonvalleyhispanic@gmail.com to request a Hardship Application
You can send to us your membership dues payment according to your membership category by one of two ways:

1) You can charge it to any credit or debit card of your choosing. Please provide us with the following information that appears below (4% will be added to any credit or debit card charges to cover our transactional fees and processing fees):
Credit Card Number
Expiration Date
CID Number
3 digits in the back after signature strip or 4 digits in front for Amex
Billing Zip Code
2) Send a check payable to: “Hudson Valley Hispanic Bar Association”. Please forward the check to:

Soto Law, PLLC, Attn: Andrea C. Soto, Esq., P.O. Box 685, Mamaroneck, New York 10543
Should be Empty: