Membership Application

(Please Print Clearly)

 

Title………………………………………………………………………………..

 

Full Name………………………………………………………………………….

 

 

Firms address……… ………………………………………………

 

                                   

……………………………………………………………………………………..

 

                                    ……………………………………………………………………………………..

 

 

DX…………………..…… Tel.No ………..……………

 

Fax No………. ..  …………………... Email:  …………………………

 

 

Does your firm have a website Yes/No. If yes, address…

Date admitted as a solicitor……../……/………

 

 

Areas of specialism……………………………………………………………………

 

……………………………………………………………………………………..

 

Are you a member of a panel, if so which ones………………………………………..

 

………………………………………………………………………………………….

 

 

Do you undertake LSC Contract work yes/no if yes in which areas…………………..

 

………………………………………………………………………………………P.T.O.

 

 

Signature of applicant…………………………………………………………………

 

 

 

Nominated by ……………………………………………………Signature

 

Please print name………………………………………………………………….

 

Name of Firm ……………………………………………………………………

 

 

Seconded by ………………………………………………………Signature

 

Please print name………………………………………………………………….

 

Name of Firm ……………………………………………………………………

 

 

Both signatures to this nomination must be members of the Society

 

Once fully completed please return this form to:

 

Phil Smith

Administrator

Northamptonshire Law Society

Ashtrees Cottage

21 Saxon Rise

Duston

Northampton NN5 6HP

 

 

Tel: 01604-585653 for further information.

 

For society use only

 

 

Before council ……………………………….…………………….

 

 

Letter of acceptance sent