DO NOT SEND PAYMENT WITH YOUR PETITION! ONCE ADMITTED, YOU MUST PAY FEES BY CREDIT CARD VIA CM/ECF. UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF GEORGIA PETITION FOR ADMISSION TO PLEAD AND PRACTICE PRO HAC VICE The Petition of _______________________________ respectfully shows that petitioner is now a member in good standing of the State Bar of ____________________, as evidenced by State Bar Number ________________ and is a member in good standing of a U.S. District Court as evidenced by the attached Certificate of Good Standing from the U. S. District Court where he/she is admitted to Practice. Wherefore, petitioner, after taking the below Oath of Admission, prays that he/she be admitted as an Attorney, Solicitor, and Proctor to plead and practice pro hac vice in the United States District Court for the Middle District of Georgia for case number _______________________________________ to represent ______________________________________________________. (name of plaintiff/defendant) OATH ON ADMISSION (PRO HAC VICE) I, ______________________________________, do solemnly swear, that as an attorney and as a counselor of this Court for the above said case, I will conduct myself uprightly and according to law, and that I will support the Constitution of the United States of America. I further affirm that I have read the Standards of Conduct set forth in the Preamble to this district's Local Rules, and I will strive to comply with these standards in my practice before this Court. ELECTRONIC FILING: * Upon admission to plead and practice pro hac vice, I understand that I will be registered to file electronically in the Middle District of Georgia. The password issued by the court combined with the login serves as and constitutes a legal signature. Registration as a user constitutes (a) consent to receive notice electronically where notice is required by statute or rule and waiver of notice by any other means; and (b) consent to electronic service and waiver of service by any other means, except for original process. DATE: __________________________ __________________________________________ FULL SIGNATURE OF PETITIONER NUMBER OF CASES I APPEARED PRO HAC VICE IN THE U.S. DISTRICT COURT FOR THE MIDDLE DISTRICT OF GEORGIA IN THE LAST 12 MONTHS: ___________ __________________________________________ LAW FIRM ADDRESS (Street or P.O. Box) __________________________________________ CITY, STATE & ZIP CODE TELEPHONE # __________________________________________ EMAIL ADDRESS (Required) =============================================================================================== ORDER IT IS ORDERED that Petitioner is hereby admitted to plead and practice pro hac vice as Attorney, Solicitor, Counselor, and Proctor. DATE: __________________________ _______________________________________________ DAVID W. BUNT CLERK, U. S. DISTRICT COURT MIDDLE DISTRICT OF GEORGIA American LegalNet, Inc. www.FormsWorkFlow.com