UNITED STATES DISTRICT COURT DISTRICT OF KANSAS ANNUAL REGISTRATION JULY 1, 2008 THROUGH JUNE 30, 2009 DUE DATE: July 1, 2008 ATTORNEY ADDRESS INFORMATION Please check here if your address has changed since the previous registration period Please print or type KS Bar#: Last: Date of Birth: First: M.I.: Generation (ie. Jr., III) Firm Name: Street Address: Suite Number: City/State Zip Code: Office Phone (Main Number): Private Extension Fax Email address: Pursuant to the rules of this court, I hereby register as a member of the bar of the United States District Court for the District of Kansas for the 12-month period beginning July 1, 2008. I certify that: 1. I am now a member in good standing of the bar of this court. 2. I am now a member in good standing of the bar(s) of (place a check mark next to one or both as appropriate): Kansas Western District of Missouri 3. To my knowledge there are NO disciplinary or suspension proceedings pending against me in any court of the United States or of any state, territory or possession of the United States. NOTE: If proceedings ARE pending at this time, please explain on the reverse side of this form. 4. During the 12-month period preceding the date of this application I have earned the required credit hours of continuing legal education and am in compliance with the rules of (place a check mark next to one or both as appropriate): Kansas Western District of Missouri 5. I have taken the oath or affirmation prescribed by the rules of this court and acknowledge that I remain bound thereby. 6. I have read and am familiar with the Rules of Practice and Procedure of this court. Signature Date By signing below I agree to serve on the Civil Pro Bono Panel and realize that on occasion the court may appoint counsel for indigent parties in civil litigation. As a member of the panel I understand that I may be reimbursed for out-of-pocket expenses which the client is not able to pay according to the Reimbursement Procedures for Court-Appointed Counsel in Civil Cases pursuant to D. Kan. Rule 83.5.3(e)(2) and (f). These expenses include items set out in 28 U.S.C. 1920, fees for expert witnesses and other out-of-pocket expenditures which counsel are reasonably compelled to incur and which are not otherwise recoverable in the action, but no reimbursement shall be made for general office overhead or items and services of a personal nature. To qualify for reimbursement, all expenditures must be approved in advance. ________________________________________________________ Signature American LegalNet, Inc. www.FormsWorkflow.com ACTIVE STATUS An ANNUAL FEE of $50.00 is required of all attorneys to practice law before this Court. To assure proper registration please mail this form with payment to: Clerk, US District Court P.O. Box 2219 Topeka, KS 66601-2219 Make checks payable to: Clerk, U.S. District Court Please e-mail questions to: ksd_attorney_registration@ksd.uscourts.gov NOTE: The District of Kansas reserves the right to use information provided on this form to develop an on-line registration system. By completing this registration form, you acknowledge that the information you provide may be incorporated into such a system. The District of Kansas does not sell, share or rent information to anyone outside of the court. INACTIVE STATUS Complete this section ONLY if you are requesting to be placed on "INACTIVE" STATUS. I wish to be placed on "inactive" status at this time. I understand I may not practice in this Court while on "inactive" status. In addition, I do not have to pay an annual fee while on "inactive" status. Signature Date 2009 LOCAL RULES Please indicate your preference regarding a bound copy of the 2009 Local Rules for the District of Kansas. I wish to receive a bound copy of the court's Local Rules. I DO NOT wish to receive a bound copy of the court's Local Rules. American LegalNet, Inc. www.FormsWorkflow.com