Membership Application Form

DDBA Membership Application

To apply for membership please complete all questions. Your membership will not be activated until payment in full is received (with the exception of students, as their member fees are free).
Name*

First NameLast Name
Firm Name. If you're a student, please enter the name of your law school.*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years Admitted. If you're a student, please enter the Term/Year date.*
E-mail*
example@example.com
Contact Number*
Format: (000) 000-0000.
Member Type. If you have not already done so, please use the PayPal QR Code below to submit payment.*

Licensed 6+ years ($100)Licensed 2-5 years ($75)Licensed 0-1 years ($50)Affiliate (non-attorney) ($50)Student ($0)
Please indicate any committees you are interested in joining

Community OutreachStudent OutreachMentorshipMembershipEventsVoting/Elections
Date of Signature*

MonthDayYear
Date
Signature*
Should be Empty:

DDBA Membership Application