SIMON E. SOBELOFF LAW SOCIETY

APPLICATION FOR MEMBERSHIP

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Name                                                                                                      Bar Membership/State/Year

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___________________________________                              Area(s) of Practice

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Address                                                

Office Phone:   ________________________             Home Phone: ________________(optional)

Fax Number:    ________________________             

Email Address: ________________________

Temple Affiliation: ____________________ (optional)

Area(s) of Interest (programming, membership, social action, fundraising): ___________________________

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Suggestions for Programming or other Events: ______________________________________

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Annual Dues:         Membership Fee $36.00    Sustaining Membership Fee $50.00

                                                                (Membership fees are not tax deductible)

All checks should be made payable to THE SIMON E. SOBELOFF LAW SOCIETY

and mailed to: P.O. BOX 1312, ROCKVILLE, MARYLAND 20849