APPLICATION FOR RENEWAL OF MEMBERSHIP ON THE CRIMINAL JUSTICE ACT MISDEMEANOR PANEL FOR THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND NAME: Office Address: Office Phone E-Mail ___________________________________________________________ ___________________________________________________________ ________________________ Cell Phone:______________________ ___________________________________________________________ 1. Please check the appropriate box: RENEW my membership on the CJA Misdemeanor panel. TERMINATE my membership on the CJA Misdemeanor panel. 2. If you are renewing please indicate where your income should be credited: Social Security # ___________________ OR EIN # ________________________ 2. DUTY DAY ASSIGNMENTS MOST CJA ASSIGNMENTS ARE MADE THROUGH DUTY DAY APPOINTMENTS You must volunteer to accept duty day appointments. Please remember, that while we do check each docket to verify there are sufficient appointments for the Office of the Federal Public Defender and the panel attorney, there is always a possibility that changes to a docket may be required, or that clients may fail to appear. If there are insufficient cases to provide an appointment to the duty day attorney, then the court cannot compensate you for the time spent in court on your duty day. Please let me remind you that claims for travel time are limited to actual driving time to each court location, not to exceed one hour, and your mileage reimbursement is limited to the lesser of your actual mileage or forty miles for each court appearance. I am interested in serving at Aberdeen ___________ Andrews Air Force Base ___________ Greenbelt ___________ Fort Meade ___________ (held in Baltimore) Hyattsville ___________ (held in Greenbelt) 3. I have served as a duty day attorney in the past year YES/ NO if yes, provide the name of the presiding judicial officer and the court location. ____________________________________________________________ ____________________________________________________________ If no, list prior trial experience in state or federal courts. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 4. Disciplinary Actions: Have you been the subject of any disciplinary actions since your admission to the CJA Misdemeanor panel? If your answer is yes, please explain on a separate sheet of paper bearing your name and address, what the nature of the conduct was and what if any disciplinary action was imposed. 5. Please indicate whether you have any special qualifications, such as fluency in a foreign language, which you believe the Selection Committee should be aware of in reviewing your application. _______________________________________________________________ PLEASE NOTE: To renew your panel membership you must review the misdemeanor manual (the manual can be located on the court’s web site www.mdd.uscourts.gov in the CJA section) and agree to attend training sessions provided at no charge by the Court. I certify that I have read the Misdemeanor Practice Manual. I agree to attend the misdemeanor panel training provided by the court. I understand that failure to attend the training sessions may result in my termination from the misdemeanor panel. I declare that the foregoing answers and statements are true and correct. (Signature of Applicant) ALL RESPONSES MUST BE RECEIVED BY THE CJA SUPERVISING ATTORNEY BY SEPTEMBER 20, 2005. The renewal of membership form should be mailed to: Donna P. Shearer, Esq. CJA Supervising Attorney 101 West Lombard St. Room 8-A Baltimore, MD 21201 American LegalNet, Inc. www.FormsWorkFlow.com