Volunteer Enrollment/Profile Update Form

Volunteer Name: *

Firm: *

Street Address:

City:

State: Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP:

Telephone:

Fax #:

E-mail: *

Attorney I.D. Number:

Year Admitted to Practice:

Please check appropriately:

Disciplinary Actions

Active Status

Main Practice Concentration(s):

Other Areas of Interest (children, elderly, homeless, mentally ill):

Foreign language proficiency:

Please check all you are interested in:

I am available to volunteer for a community education legal clinic

I am available to accept an occasional emergency case requiring appearance at a hearing on very short notice (less than 10 days)

We do not share or otherwise disclose any personal information, including your name, address, or email addresses with other organizations. Only Philly VIP's staff and our authorized agents have access to personally identifiable information provided by visitors to our site.