UNITED STATES DISTRICT COURT DISTRICT OF KANSAS Pro Hac Vice Electronic Filing Registration Form Name: Office: Address: Address: City: State: Zip: Office Phone: Ext.: Fax: State Bar # Last 4 Digits of Social Security Number: Attorney222s Internet E-mail Address: Additional email addresses that should receive Notices of Electronic Filing: PRO HAC VICE ATTORNEYS: Each attorney applying for pro hac vice admission must complete and sign an Electronic Filing Registration Form and file it as an attachment to the motion for pro hac vice admission. You will receive system-generated notices of electronic filings and documents may be retrieved electronically through PACER. The District of Kansas does not permit attorneys admitted pro hac vice to file documents electronically. Local counsel is responsible for all filings. By registering, I consent to electronic service of all documents. I certify that I am a member in good standing of the bar of all courts where I am admitted. I am applying for or have been granted admission pro hac vice and I have read and am familiar with the rules of practice and the administrative procedures guide governing electronic filing, both which may be found at www.ksd.uscourts.gov. I agree to abide by the rules and regulations in the most recent general order currently in effect and any changes or additions that may be made in the future to the general order, the administrative procedures guide or this court222s local rules. Attach completed form to motion for leave to appear pro hac vice. Date Applicant222s Signature Note: You must sign this form with your original "wet" signature. The "s/ typed name" format is not allowed here. If you have questions about this form or the pro hac vice admission process, please contact the Attorney Registration clerk at 913-735-2229 or ksdattorneyregistration@ksd.uscourts.gov . American LegalNet, Inc. www.FormsWorkFlow.com