UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK NEW ATTORNEY E-FILING REGISTRATION FORM PLEASE TYPE This form is used for creating new accounts (Newly Admitted Attorneys Only) on the Court’s Electronic Case Filing System(ECF). First Name:__________________________ Middle Name:___________________ Last Name:__________________________________ If appropriate, check one: Sr. Jr. II III Firm Name:_________________________________________________________________________ Firm Address:_______________________________________________________________________ _______________________________________________________________________ City:___________________________ State:__________________ Zip Code__________ Firm Phone Number:_________________________________ Fax Number:__________________________________ Direct Dial Number:________________________________ Internet E-Mail Address: The following information must be completed by attorneys applying for admission and submitted with your petition: TYPE OF ADMISSION APPLIED FOR: PERMANENT PRO-HAC VICE - Case Number Required:____________________________ By submitting this printed and signed form, I hereby agree to abide by all Court rules, orders, policies and procedures governing the use of the electronic filing system (CM/ECF). I also consent to service by electronic means in the circumstances permitted under those rules, orders, policies and procedures. I understand that the combination of user i.d. (Bar Roll #) and password will serve as my signature for filing documents pursuant to Rule 11 of the Federal Rules of Civil Procedure, the Federal Rules of Criminal Procedure and the Local Rules of this court. I agree to protect the security of my password and immediately notify the Clerk of Court if I suspect my password has been compromised. Also, as a participating attorney, I will promptly notify the Clerk of Court if there is a change in my personal data, such as name, e-mail address, firm address, telephone number, etc. COURT USE ONLY Attorney Signature:__________________________________ Assigned Bar Roll # __________________________ Date:_____________________________________ Receipt #___________________ Date of Admission: Revised: / / / / By: 5/2006 American LegalNet, Inc. www.FormsWorkflow.com