2012 Attorney Registration Form Clerk of the District Court, 10th Judicial District Johnson County Kansas K.S.A. 20-3126 (Please print clearly or type) Kansas Supreme Court #: _____________ DUE JANUARY 15, 2012 Name: Last_______________________ First_______________ Middle_______________________ Business address: Name of firm_________________________________________________________________ Street or post office box______________________________________________ County_____________ City______________________ State____ Zip____________ Telephone: ( ) ______-_____________ Fax: ( ) ______-___________ Service/Notification Email: 1._____________________________ 2.____________________________ Residential address: Street or post office box________________________________________________ County_____________ City_____________________ State____ Zip____________ Telephone: ( ) ______-_____________ Fax: ( ) ______-_____________ If you do not have a current business address, please leave the business address portion blank. Please notify the Clerk of the District Court when a business address becomes available or changes. After your registration has been processed, you will receive your library card in the mail. The card will allow you access to the library before 8 am and after 5 pm and on weekends. This registration form and the fee of $100.00, as determined by the Board of Trustees of the Law Library, are collected in compliance with K.S.A. 20-3126. Please make your $100.00 check payable to: Johnson County Law Library Return to: Johnson County Law Library Courthouse - Room 101 100 North Kansas Avenue Olathe, KS 66061 (913) 715-4151 I certify that the information given is true and correct. ________________________________________ Signature Rev.11/11 American LegalNet, Inc. www.FormsWorkFlow.com