APPLICATION FOR MEMBERSHIP ON CIVIL PRO BONO PANEL UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW MEXICO TO: Clerk of Court Attn: Pro Bono Panel Selection Committee United States District Court 333 Lomas, NW Albuquerque, NM 87102 1 . Social Security No. Name of Applicant Address & Zip (Business) Address & Zip ( Residence) Business Phone Residence Phone 2. Location of your availability (check appropriate location(s)): Santa Fe Albuquerque Las Cruces 3. You must be a member in good standing of the Bar of the United States District Court for the District of New Mexico. Please enter date admitted to practice before this Court: 4. Other Courts you are admitted to practice in: Name of Court Date Admitted Location 5. How long have you actively practiced law? 6. Have you ever been disciplined by the Bar of any state or by any court? yes no If so, explain 7. Briefly describe your civil litigation experience. (Use the reverse side of page.) >>>> 28. Language knowledge, in addition to English, and level of abilities to read, writeand speak: Language Read Write Speak9. Please give the names and addresses of at least three references who arequalified to evaluate your professional capabilities as a civil attorney. 10. How many cases, in a year, would you be willing to accept as counsel? (This number is not binding; it is for administrative purposes.) -2-