Membership Applications

Contact Information

1. Check here if you have previously been a Dayton Bar member
   
   
2. Mr. Mrs. Ms. Hon. Mag. Prof. Dean
3. *First Name
4. Middle Name
5. *Last Name
6. Maiden Name
7. *Date of Birth

   MM/DD/YYYY

8. *Supreme Court #
9. *Email
10. *Year Admitted

    The year you were first admitted to the bar of any state, territory or district of the United States.

11. Month Admitted January February March April May June July August September October November December
12. *State Admitted AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
13. Other Years/States Admitted

Business Address

1. Firm/Business Name
2. Your Title
3. *Street Address
4. Suite/Floor
5. *City
6. *State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
7. *Zip
8. *Business Phone

   (XXX) XXX-XXXX

9. Direct Phone Extension

   (XXX) XXX-XXXX

10. *Business Fax
11. Firm/Business Website

Home Address

1. Address
3. City
4. State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
5. Zip
6. Phone

   (XXX) XXX-XXXX

Additional Information

1. Preferred Mailing Address Business Home
2. Preferred Directory Address Business Home Do not include my contact information

   NOTE: If we have no record of your employment, your home address will be used in the Directory.

3. *Law School

   Law School Attended

4. Law School Graduation Date
5. Spouse's Name

Demographic Information: This information is used for statistical purposes only.

1. Gender Male Female
2. Fields of Practice

Committees

Appointment to listed committees is open equally to all members. Service requirements vary, but all committees encourage regular attendance. Most committees meet once a month, usually at noon. Check below the committees you would like to join. Appointment is automatic - except as noted below. Meeting dates are listed online at www.daybar.org and in the Dayton Bar Briefs.

Optional

1. Lawyer Referral Service
   If you would like more information on the Lawyer Referral Service, please check here.
2. Personnel Placement Service
   If you would like more information on the Personnel Placement Service, please check here.
3. 
   Below are the individuals that I would like to refer to the DBA for membership. Please include name, phone number & email. (ex. Jane Smith, 937-123-4567, jane@somelawfirm.com;)