IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO APPLICATION FOR ADMISSION TO THE BAR OF THE COURT This application for admission MUST BE COMPLETED IN ITS ENTIRETY. Please be advised that an incomplete application will be returned to the applicant, which will delay processing and review of the application, with a resulting delay in the admission to the bar of this court. Pursuant to D.C.COLO.LCivR 83.3 and D.C.COLO.LCrR 57.5, admission to the bar of this court is limited to persons licensed by the highest court of a state, federal territory or the District of Columbia; who are on active status in a state, federal territory or the District of Columbia; and who are in good standing in all courts and jurisdictions where admitted. FULL NAME, INCL. MIDDLE NAME (IF NONE, SO INDICATE): )(F (M ) OTHER NAMES USED (IF NONE, SO INDICATE): FIRM/ORGANIZATION/CORPORATION NAME (STATE NONE, IF NOT AFFILIATED): FIRM ADDRESS: STATE: CITY: OFFICE TELEPHONE: ( ZIP: ) OFFICE FAX: ( ) EXACT DATE OF BIRTH: _______________ EXACT CITY/STATE OF BIRTH: ALTERNATIVE PHONE (RESIDENCE or CELLULAR): 1. I received my license(s) to practice law in (State, Federal Territory or D istrict of C olumbia) , on . (D ate) My attorney registration number is . Full Address of Licensing Court: (If admitted in more than one jurisdiction by examination or the equivalent, attach a separate sheet giving additional information.) 2. Additionally, I am admitted to practice in the following courts (attach a separate sheet if necessary, and if not admitted in other courts, so indicate): Court: Full Address: Date of Admission (mm/dd/yy): Registration No. (If none issued by court, so indicate) American LegalNet, Inc. www.FormsWorkFlow.com 3. I certify I am a member in good standing in all courts to which I have been admitted. 4. Have you ever been disbarred, suspended, censured, or received a reprimand pertaining to your conduct or fitness to practice law or membership in the bar of any court or other attorney licensing agency? No Yes If the answer is "Yes", attach a separate sheet or sheets giving a full explanation, including date, address and telephone number of the court or licensing agency, discipline imposed, and date and conditions of reinstatement (if any). 5. I consent to this court's exercise of disciplinary jurisdiction over me in connection with this application and any alleged misconduct related to my admission to and practice before the bar of this court. 6. I certify that I have read and am familiar with the local rules of this court and that I will comply with all of the provisions thereof. 7. I recognize that, if admitted to the bar of this court, I am duty bound to give immediate written notice to the clerk of this court of any formal discipline imposed upon me, including dates and terms thereof, by any court or attorney licensing agency. 8. I solemnly swear (or affirm) that as an attorney and counselor of this court, I will conduct myself in a professional and ethical manner at all times, and that I will support and defend the Constitution of the United States. Signature Subscribed and sworn to before me this day of , My Commission Expires: Notary Public THIS APPLICATION SHOULD BE ACCOM PANIED BY A CHECK IN THE AM OUNT OF $160.00 (ONE SEPARATE CHECK FOR EACH ATTORNEY SEEKING ADM ISSION) M ADE PAYABLE TO "THE CLERK, UNITED STATES DISTRICT COURT." UPON ADM ISSION YOU M UST REGISTER FOR AN ELECTRONIC FILING ACCOUNT AT W W W .COD.USCOURTS.GOV. Gregory Langham, Clerk United States District Court Alfred A. Arraj U.S. Courthouse, Room A-105 901 19th Street Denver, Colorado 80294-3589 Phone (303) 844-3433 Rev. (05/01/10) American LegalNet, Inc. www.FormsWorkFlow.com