Dallas Gay and Lesbian Bar Association 2015 Membership Form You do not need to be a member of the Dallas Bar Association to be a member of the DGLBA. Name: _______________________________ Firm/Organization:_______________________________ E-mail Address: _______________________________________________________________________ Website: _____________________________________________________________________________ Telephone: ___________________________________________________________________________ Mailing Address: ______________________________________________________________________ Membership Levels: $35 Attorney or other non-attorney professional $25 Judge, Court Staff, Government Employee, or non-profit employee $20 Law student, non-licensed attorney, and paraprofessionals I would like for my information to be published on www.dglba.org and www.dglba.com under the practice areas selected below. Please add $10 to your dues for each practice area you would like to be listed under on the website. Please check, X, or make other visible markings for the preferred areas you wish to be listed: o Appellate Law o Entertainment Law o Other – Non-Attorney o Auto/Car Crash o Family Law o Patent, Trademark, and o Bankruptcy o Immigration Copyright Law o Collaborative Law o Intellectual Property o Personal Injury o Corporate Law o Labor and Employment o Probate o Criminal Defense o Litigation o Real Estate o Disability o Media & Internet Law o Slip and Falls o Estate Planning o Medical Malpractice I would like to help with or learn more about: Presenting a CLE program at one of our monthly meetings. Hosting or helping with a networking and/or social event. Please make checks payable to DGLBA and mail to: DGLBA c/o Aaron Parrish, 7616 LBJ Freeway, Suite 401, Dallas, Texas 75251 If you are paying with a credit card, you may return your completed form via email to [email protected]. PAYMENT METHOD: Amex Visa MasterCard Discover Check Card Number: Amount Paid: $ _____ ________________________ Signature Expires: || CVV: Billing Address if different from above: _____________________ _____________________ _________________________ Cardholder Name (please print)
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