REGISTRATION OF ATTORNEY SPECIALTY FORM: RPC 7.4(d)(3) State Bar of Nevada PO Box 50 Las Vegas, NV 89125-0050 Phone: (702) 382-2200 Toll Free (800) 254-2797 Fax: (702) 385-2878 DATE SUBMITTED: __________________ SUBMITTED BY: _________________________________ ____________ Attorney name Bar number _________________________________ Firm name _________________________________ Address _________________________________ _________________________ ______________________________ Phone number E-mail 1. Specialty registered: __________________________________ List as you will be advertising your specialty □ Proof of certification attached i.e. copy of certificate indicating expiration date • Certification issued by: __________________________________ Name of approved organization that certified you • This certification was first issued _________ and is valid through ___________. Date Date 2. Are you registering more than one specialty? □ Yes □ No You must attach a completed copy of this form, with the exception of #3 (fee) for each additional specialty (up to three total). There is only (1) fee if you register multiple specialties at this time or at annual renewal. Additional specialties added at another time will be assessed a one-time $50 processing fee. 3. Process my $250 registration fee by: □ Check (enclosed) Please mail original application with payment to: State Bar of Nevada PO Box 50 Las Vegas, NV 89125-0050 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 4. Attestation By signing and submitting this form, the undersigned attests to compliance with each of the following (INITIAL each item): _____ I have verified that the organization which certifies my specialty as designated in item #2 herein is currently ABA Certified, or, approved by the State Bar of Nevada Board of Governors. _____ I have devoted at least one-third of my practice to the specialty designated in item #1 herein for the past two (2) years. _____ I have completed ten (10) hours of continuing legal education in the area of my designated specialty in the past year as follows: □ Proof of attendance attached OR □ List courses below: ___________________________________________ ___________________________________________ ___________________________________________ ______ Professional liability insurance verification- Complete one of the following as it applies to you: _____ I currently carry at least $500,000 in professional liability insurance. □ Proof of my coverage is attached. (Required. RPC 7.4(d)(2)(iii). ) ______ I am exempt from liability coverage under RPC 7.4 because I practice exclusively public law. ______ I am concurrently filing a copy of this form and its attachments with the Mandatory Board of Continuing Legal Education, 457 Court Street, Reno, NV 89501. (Required. RPC 7.4(d)(2)(iv).) ORIGINAL SIGNATURE OF ATTORNEY REGISTERING SPECIALTY I have personally read this form and attest to the accuracy of the information contained therein. Please do not fax this application as an original signature is needed. Dated this ____________ day of _______________________, ___________. _____________________________________________________ Print Name _____________________________________________________ Sign Name Please submit an original application. If you have questions please call Member Services, 702-382-2200. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com