PETITION FOR ADMISSION TO PRACTICE FOR MEMBERS OF KANSAS BAR Instructions for completing the Reciprocal form: > > > > Print or type the application; signature and date required Return to forwarding address provided on application Submit the required $150.00 registration fee No swearing-in required Simply mail the form back to us and you will be entered into our database as an admitted attorney in “active” status. Requirement to maintain “active” status with the Western District of Missouri pursuant to Local Rule No. 83.5: (local rules are available via the Internet at http://www.mow.uscourts.gov) > Annual dues - As an Attorney admitted to the Western District of Missouri is required to pay annual dues by March of each year. > Important Note: Failure to comply with the above requirement will result in the attorney’s status lapsing to “inactive” status. A reinstatement fee and a letter requesting reinstatement is required to be reinstated to “active” status. Questions regarding the above information should be directed to: Jeri Russel, Attorney Admissions, WDMO - Jefferson City, by phone at (573) 636-4015; or by fax at (573) 636-3456; or by mail at 80 Lafayette Street, Jefferson City, MO 65101 American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI PETITION FOR ADMISSION TO PRACTICE FOR MEMBERS OF KANSAS BAR Name Soc. Sec No. Firm Name Date of Birth Address Email City Fax State Will serve as Law Clerk (if applicable) to: Alabama Zip Phone No. Attorney Type (Check all that apply): Civil Judge's name Criminal Bankruptcy Complete the following: For admittance under U.S. District Court of Kansas Guidelines: U.S. District Court, Kansas Bar No. Date of Admission: I am in good standing of the United States District Court, District of Kansas. Date Signature Please forward application to: U.S. Courthouse Attn: Attorney Admissions 80 Lafayette Street Jefferson City, MO 65101 In accordance with the Reciprocity Agreement: $150.00 registration fee No swearing-in required Receipt Number: Date: Admission Date: To maintain “active” status in the U.S. District Court, Western District of Missouri, you must pay annual dues by March 31 of each year. A notice will be sent to you from the Court at the beginning of each year. Certificate mailed: American LegalNet, Inc. www.FormsWorkFlow.com