Tampa Bay Trial Lawyers Association


	Margaret Schumacher, M.S. CFRE Executive Director Tampa Bay Trial Lawyers Association P.O. Box 26091 Tampa, FL 33623 Phone: (813) 769-3460 Fax: (866) 613-7071

TAMPA BAY TRIAL LAWYERS ASSOCIATION
Membership Application -
$150.00 fee for members who have been practicing law less than 5 years.
$200.00 fee for members who have been practicing law for 5 years or more.

You must complete the form below to be considered for membership of the Tampa Bay Trial Lawyers Association. Membership period is from January 1 to December 31. In order to utilize all the benefits of membership, it is necessary that your annual dues be paid by February 1.
* denotes fields that are required.

Title:	Mr. Mrs. Ms. Dr.
First:*		Last:*
Firm:*		Bar#:*
Address:*		Suite #:
City:*		State:*	Zip:*
County:*
Phone:*		Fax:*
E-mail:*
Password:*	If you would like a password for the TBTLA Document Database other than your Florida Bar number, please include your selected PASSWORD:*

Please attach a Resume, Curriculum Vitae, or your biographical information in the form of a PDF, TIF, or Word document. Please list the names of the attorneys in your current firm. As an alternative to attaching a document, you may insert your biographical information in the space provided below, or you may mail the information to TBTLA, Post Office Box 26091 Tampa, FL 33623.
File:

1) Please list two current TBTLA members with whom you are familiar with as your references:
Name:*
Name:*
2) Describe the percentage of your areas of practice, your firm�s areas of practice, and the number of years you have been practicing in each area of law.
	Your areas of practice/Number of years	Firm's Practice:
Plaintiff Personal Injury:	% years	%
Defense Personal Injury:	% years	%
Other Plaintiff: (Please provide description below)	% years	%
Other Defense: (Please provide description below)	% years	%
Total:	100%	100%
Other Plaintiff Description:
Other Defense Description:
3) If the applicant has ever practiced personal injury defense, including but not limited to medical malpractice, nursing home, and workers compensation defense, please state the following:
The names and locations of all law firms where you have practiced personal injury defense, along with the dates of employment with each law firm:
The total number of years you practiced personal injury defense, along with the month and year you stopped practicing personal injury defense:
4) Are you now associated with any law firm or lawyer practicing in the area of personal injury defense, or sharing office space with any law firm or lawyer practicing personal injury defense, or sharing office space with any law firm or lawyer practicing personal injury defense? If so, state the name and location of the law firm you are associated with or are sharing office space with:

5) I am currently a member of:
Florida Justice Association (FJA) (formerly the (AFTL) Academy of Florida Trial Lawyers):		Yes No
American Justice Association (formerly the (ATLA) Association of Trial Lawyers of America):		Yes No
6) I prefer to receive updates and communications via:
E-mail Fax
7) Please let us know how you heard about the TBTLA:

* I understand by checking this box that my application will be reviewed by the Board of Directors for the Tampa Bay Trial Lawyers Association and will be voted on for acceptance following their review.
* I understand by checking this box that payment of the $150.00 or the $200.00 membership fee will be due upon notification of acceptance.