UNITED STATES DISTRICT COURT DISTRICT OF ALASKA Case No. Plaintiff(s), vs. MOTION AND APPLICATION OF NON-ELIGIBLE ATTORNEY FOR PERMISSION TO APPEAR AND PARTICIPATE IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ALASKA Defendant(s). To the Honorable Judge of the above-entitled court: I, (name) , hereby apply for permission to appear and , (Name of party) participate as counsel for , (plaintiff/defendant) in the above-entitled cause pursuant to Rule 83.1 (d) of the Local Rules for the United States District Court, District of Alaska. I hereby apply for permission to appear and participate as counsel WITHOUT ASSOCIATION of local counsel because [check whichever of the following boxes apply, if any]: I am a registered participant in the CM/ECF System for the District of Alaska and consent to service by electronic means through the court's CM/ECF System. I have concurrently herewith submitted an application to the Clerk of the Court for registration as a participant in the CM/ECF System for the District of Alaska and consent to service by electronic means through the court's CM/ECF System. For the reasons set forth in the attached memorandum. American LegalNet, Inc. www.FormsWorkFlow.com OR I hereby designate (Name) , a member of the Bar of this court, who maintains an office at the place within the district, with whom the court and opposing counsel may readily communicate regarding conduct of this case. DATE: (Signature) (Printed Name) (Address) (City/State/Zip) (Telephone Number) (e-mail address) Consent of Local Counsel* I hereby consent to the granting of the foregoing application. DATE: (Signature) (Printed Name) (Address) (City, State, Zip) (Telephone) (*Member of the Bar of the United States District Court for the District of Alaska) American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION OF NON-ELIGIBLE ATTORNEY Full Name: Business Address: (Mailing/Street) , (City, State, ZIP) Residence: (Mailing/Street) , (City, State, ZIP) Business Telephone: Other Names/Aliases: e-mail address: Jurisdictions to Which Admitted and year of Admission: (Jurisdiction) (Jurisdiction) (Jurisdiction) (Jurisdiction) (Address) (Address) (Address) (Address) (Year) (Year) (Year) (Year) Are you the subject of any pending disciplinary proceeding in any jurisdiction to which admitted? Yes No (If Yes, provide details on a separate attached sheet) Have you ever been suspended from practice or disbarred in any jurisdiction to which admitted? Yes No (If Yes, provide details on a separate attached sheet) In accordance with D.AK. LR 83.1(d)(4)[A](vi), I certify I have read the District of Alaska local rules by visiting the court's website at http://www.akd.uscourts.gov and understand that the practices and procedures of this court may differ from the practices and procedures in the courts to which I am regularly admitted. A Certificate of Good Standing from a jurisdiction to which I have been admitted is attached. Pursuant to 28 U.S.C. §1746, I hereby declare under penalty of perjury that the foregoing information is true, correct, and accurate. Dated: (Signature of Applicant) American LegalNet, Inc. www.FormsWorkFlow.com