IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS SOLE PRACTITIONER REGISTRATION FORM (Please select one of the following) Registration with Circuit Clerk Change of Address Change of Firm Attorney Name: First Name _____________________ MI ___ Last Name ____________________________ ARDC No. ____________________________ Present Business Address: Firm Name: _________________________________ Address: ____________________________________ City, State, Zip _______________________________ Phone Number: ____________________ Fax Number:____________________ Email Address: ___________________________________________________ New Business Address: Effective ___________________ Firm Name: _________________________________ Address: ____________________________________ City, State, Zip _______________________________ Phone Number: ____________________ Fax Number:____________________ Email Address: ___________________________________________________ Date ____________________ _____________________________ Signature American LegalNet, Inc. www.FormsWorkFlow.com