Application for Admission Pro Hac Vice Applicant Informa on Applicant Name_______________________________________________________________________________ Firm ________________________________________________________________________________________ Mailing Address ______________________________________________________________________________ City/State/Zip ________________________________________________________________________________ Phone ______________________________________________________________________________________ E-mail ______________________________________________________________________________________ Jurisdic ons Please list all states in which you are licensed to prac ce law as well as your a orney number for each. DO NOT include federal courts or previous Pro Hac Vice admissions. Please a ach cer ficate(s) of good standing from the states in which you are licensed to prac ce (even if inac ve) dated no more than 30 days prior to the date of the applica on. Jurisdic on _________________________________________________ Jurisdic on _________________________________________________ Jurisdic on _________________________________________________ Jurisdic on _________________________________________________ Jurisdic on _________________________________________________ Jurisdic on _________________________________________________ A orney Number ________________ A orney Number ________________ A orney Number ________________ A orney Number ________________ A orney Number ________________ A orney Number ________________ Case Informa on Please provide the following informa on for the case in which the applicant wishes to appear: Cap on _____________________________________________________________________________________ Court and County _____________________________________________________________________________ Case Number_________________________________________________________________________________ Party Applicant Represents ______________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com P.O. Box 109, Cheyenne, WY 82003 · (307) 632-9061 · Fax: (307) 632-3737 Discipline History Have you been disciplined in any other jurisdic on within the prior seven years? No Yes (Please a ach a copy of all orders of discipline.) Cer fica on By checking the boxes below, the applicant cer fies the following: (all boxes must be checked) I will submit to the disciplinary authority and procedures of the Wyoming State Bar. I am familiar with the Wyoming rules of procedure and evidence, including applicable local rules. I will be available for deposi ons, hearing and conferences. I will comply with the rulings and order of the court. Local Counsel Pursuant to Rule 8 of the Rules Governing the Wyoming State Bar and the Authorized Prac ce of Law, the applicant must associate with local counsel. Please name an ac ve member of the Wyoming State Bar who has agreed to serve as local counsel in the ma er referenced on the previous page. A orney Name _______________________________________________ A orney Number ______________ Firm ________________________________________________________________________________________ Mailing Address ______________________________________________________________________________ City/State/Zip ________________________________________________________________________________ Cer ficate of Compliance Upon approval, the Wyoming State Bar will issue a Cer ficate of Compliance with Rule 8. The original cer ficate will be sent to local counsel and a copy of the cer ficate will be sent to the applicant. I have read the foregoing applica on and the informa on contained herein is true and correct. STATE OF COUNTY OF ___________________________ ) ) ss. ___________________________ ) Signature of Applicant Signed and sworn to before me this _____________ day of _______________________ 20 _______ . Notary Public My commission expires ____________________________ (affix seal) Payment Informa on - $500 (non-refundable) Payment Enclosed (Check or money order made payable to the Wyoming State Bar) Charge my credit card credit card number billing address city/state/zip American LegalNet, Inc. www.FormsWorkFlow.com security code expira on date