G-129 (06/19) Page 1 of 3TEL: 213-894-5708LawyerRepsCACD@cacd.uscourts.gov(Complete this form and email to the address above.)1.Name:2.Business Address (include firm name, phone and fax numbers, and email address):3.Home Address:4.State Bar Number:5.Describe with specificity the nature of your practice, including areas of emphasisand specialization certified by the State Bar of California. (Please attach a copy ofyour current curriculum vitae.) www.FormsWorkFlow.com G-129 (06/19) Page 2 of 36.What percentage of your practice involves litigation in federal court?7.What percentage of your practice involves litigation in state court?8.Have you ever been disciplined or cited for a breach of ethics or unprofessionalconduct by, or been the subject of a complaint to any court, administrative, barassociation, disciplinary committee, or other professional group? If so, providethe particulars, including the applicable dates and disposition. (Identify everycomplaint even if it was dismissed or did not result in disciplinary action.)9.Have you, to your knowledge, ever been under federal, state, or local investigationfor possible violation of a criminal statute? If so, provide the particulars.10.Why do you want to be a lawyer representative? Why do you believe you arequalified? What would you seek to accomplish if selected? How many hours permonth will you be able to contribute to the work of the 9th Circuit JudicialConference?11.Are you now serving, or have you ever served, as a lawyer representative? If so,list the dates of your service.Application for Ninth Circuit Judicial Conference Lawyer Representative United States District Court, Central District of California www.FormsWorkFlow.com G-129 (06/19) Page 3 of 3Application for Ninth Circuit Judicial Conference Lawyer Representative United States District Court, Central District of California12.Are you now serving, or have you previously served, on a Ninth Circuit Committeeor Board? If so, list the committee or board and the dates of your service.13.List your 10 most recent federal cases by name, case number, and judge.I declare under penalty of perjury that the answers and statements provided by me in this application are true and correct.Name: Signature:(Type or Print)Executed at: on Attachment: Curriculum Vitae www.FormsWorkFlow.com