ICCBA Associate Membership Application

ICCBA Associate Membership Application

Name:*

First NameLast Name

E-mail Address:*

All information will be kept strictly confidential

Phone Number:*

Country CodePhone Number

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Nationality:

Languages*

EnglishFrenchOther (please specify)Other

Are you a member of any other Bar Associations?*

YesNoOther

Please confirm one of the following:*

I confirm I am admitted to the ICC List of AssistantsI confirm I am assigned as support staff on a case at the ICC

If admitted to the List of Assistants, please enter the year you were admitted to ICC List of Assistants:

If you are assigned to a case at the ICC, please indicate the case here:

Please note all membership applications are subject to meeting the criteria set out. We will endeavor to reply as soon as possible to all applications.

The ICCBA will only use your information to send you relevant information regarding your membership and will not share your information with any third parties. By giving your consent you will receive relevant communications from the ICCBA.*

Yes, I ConsentNo, I do Not Consent