UNITED STATES DISTRICT COURTfor the EASTERN DISTRICT of MISSOURI APPLICATION FOR ADMISSION TO PRACTICE LAW**Please PRINT or TYPE**Name (First , Middle Initial, Last ) Home Address: City: ST: Zip: Home Phone: Date of Birth: Social Security #: Law School: Year Graduated: Personal Email Address: REGULARLY ENGAGED IN THE PRACTICE OF LAW AT:Firm Name: Address:Phone: Ext.: Fax #: Primary Email Address:Secondary Email Address: LIST STATE TO WHICH YOU ARE ADMITTED TO PRACTICE LAW: STATEYR. ADMITTEDCURRENT STATUSI.D. NUMBER Please include current* certificate o good standing from jurisdiction . LIST FEDERAL COURTS TO WHICH YOU ARE ADMITTED TO PRACTICE LAW: COURTYR. ADMITTEDCURRENT STATUS *Must be issued no more than 60 days prior to submitting application. American LegalNet, Inc. www.FormsWorkFlow.com - 2 - 991.992.993.994.995.996.997.998. American LegalNet, Inc. www.FormsWorkFlow.com APPLICANT222S NAME:Explanation(s) to Questions 1-8 American LegalNet, Inc. www.FormsWorkFlow.com APPLICANT222S NAME ACKNOWLEDGMENT of OBLIGATION REGARDING APPOINTMENTS I understand that by signing this application I agree upon admission to the bar of the EasternDistrict of Missouri, to represent without compensation, indigent parties in civil matters when soordered by a judge of the Court, and to accept appointments by a judge to represent indigentcriminal defendants under the Criminal Justice Act unless exempt by rule or statue, except whensuch representation would create a conflict of interest. AFFIRMATION I swear/affirm that the information provided in the foregoing application is true and correct. Ifurther affirm any required original certificate of good standing currently maintained in myoffice and will be maintained for a period of 90 days. I acknowledge that by accepting admissionto this court I am subjecting myself to the discipline of this court. I further certify that I haveread and am familiar with the Federal Rules of Civil Procedure, the Federal Rules of CriminalProcedure, and the Local Rules of this ourt. By registering under this rule, attorneys consent to electronic service by the ourt of alldocuments, including orders and judgments. See Local Rule 5-2.12, Fed.R.Civ.P. 5, Fed.R.Civ.P.77, and Fed.R.Crim.P. 49. DateSignatureSubscribed and Sworn to Before Me this dayof , at .Notary Public or Deputy Clerk of this Court American LegalNet, Inc. www.FormsWorkFlow.com