United States District Court Middle District of Louisiana ATTORNEY PETITION AND MOTION FOR ADMISSION TO PRACTICE BEFORE THE UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF LOUISIANA Name LA Supreme Court No. Date of Admission Firm Business Address City/State/ Zip Code Phone Fax Parish or County Email Address Date of Birth SSN Date of Admission to the US 5th Circuit (if applicable Language(s) other than English that you speak List all courts before which you are licensed to practice and the date of admission to the bar of such court or courts. American LegalNet, Inc. www.FormsWorkFlow.com G G Yes No G G Yes No G G Have you ever been disbarred or suspended from practice before any court, department, bureau, or commission of any state or of the United States or have you received any reprimand from any such court, department, bureau, or commission pertaining to your conduct or fitness as a member of the bar? If so, answer in detail and attach a separate statement if necessary Yes No Explain: Have you ever been charged with a violation of any laws or municipal ordinances other than traffic violations? If so, state when, where, and the nature and disposition of the charge. If answered in detail, attach a separate statement Explain: If you were in the armed forces, please state if you were ever courtmartialed or whether any charges were ever filed against you. If so, state the nature of the charge, the disposition and the nature of your final discharge from the service Explain: American LegalNet, Inc. www.FormsWorkFlow.com Affidavit I, ______________________________, certify that I have known applicant ________________________________________, for approximately ______ years. I am familiar with his or her reputation and moral character, such that I believe that he or she should be admitted to practice before the United States District Court for the Middle District of Louisiana. I was admitted to practice before this Court in Baton Rouge, Louisiana on the ______day of ___________________________________, ________. _____________________________________ Signature and Bar Number Affidavit I, ______________________________, certify that I have known applicant ________________________________________, for approximately ______ years. I am familiar with his or her reputation and moral character, such that I believe that he or she should be admitted to practice before the United States District Court for the Middle District of Louisiana. I was admitted to practice before this Court in Baton Rouge, Louisiana on the ______day of ___________________________________, ________. _____________________________________ Signature and Bar Number Motion for Admission I, ______________________________, a member in good standing of the Bar of the United States District Court for the Middle District of Louisiana, hereby move for the admission of ________________________________________ to the Bar of the United States District Court for the Middle District of Louisiana. I am satisfied he or she posses the necessary qualification I was admitted to practice before this Court in Baton Rouge, Louisiana on the ______day of ___________________________________, ________. _____________________________________ Signature and Bar Number American LegalNet, Inc. www.FormsWorkFlow.com I DO SOLEMNLY SWEAR (OR AFFIRM OR PROMISE) that I will support the Constitution of the United States; that I will well and faithfully discharge my duties as attorney and officer of this Court; and that I will demean myself uprightly and according to law and the recognized standards of ethics of the legal profession. I do further solemnly swear (or affirm or promise) that I have read the Federal Rules of Civil Procedure, 28 USC; the Federal Rules of Criminal Procedure, 18 USC; the Federal Rules of Evidence, 28 USC; and the Uniform Local Rules of the United States District Court for the Middle District of Louisiana, and that I am fully prepared to use and abide by them in my practice before this Court. _____________________________________ Signature of Applicant STATE OF LOUISIANA, PARISH OF_________________________________ Before me, the undersigned authority, personally came and appeared ___________________________________, to me personally known, who, being by me first duly sworn, did depose and say that the above and foregoing answers and statements were made by him or her and that they are true and correct. Sworn to and subscribed before me, this_________day of _______________________, ________. _____________________________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com Consent to Electronic Filing Pursuant to General Order 2006-10, electronic case filing shall be mandatory in the United States District Court for the Middle District of Louisiana effective March 1, 2007 for all attorneys. All documents filed with the court must be filed using the Electronic Case Filing System (ECF System), unless otherwise exempt pursuant to the Administrative Procedures governing ECF, the Local Rules, and/or court orders By signing below, I certify that I have read, understand and will abide by all administrative policies and procedures pertaining to CM/ECF. I also consent to receive notice of filings pursuant to Fed.R.Civ.P. 5(b) and 77(d) via the Court’s electronic filing system, and consent to receive service from other filing users by the Notice of Electronic Filing generated by the Court’s electronic filing system. I understand the combination of user id and password will serve as the signature of the attorney filing the documents pursuant to Fed.R.Civ.P. 11. I agree to protect the security of my password and immediately notify the court if my password has been compromised. • I will keep informed of current procedures and future procedures posted on the court’s web site at http://www.lamd.uscourts.gov/cmecf/information/procedures.htm . • I certify I have a PACER account for viewing documents on the system, appropriate computer hardware, internet access, and software, necessary for ECF filing, including hardware / software that will convert documents that I create into Portable Document Format (PDF) as required by the Court. • I acknowledge it is my responsibility to understand how to electronically file via the CM/ECF system. If necessary, I will obtain CM/ECF training via the court’s online tutorial at http://www.lamd.uscourts.gov/cmecf/demos/index.htm . _____________________________________ Signature of Applicant American LegalNet, Inc. www.FormsWorkFlow.com