American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NORTH CAROLINA IN THE MATTER OF THE APPLICATION OF FOR THE ADMISSION TO PRACTICE TO THE HONORABLE JUDGES OF THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF NORTH CAROLINA: The Petitioner respectfully certifies unto the Court that the Petitioner is a member in good standing of the bar of the Supreme Court of North Carolina and that the Petitioner has studied the Federal Rules of Civil and Criminal Procedure, the Federal Rules of Evidence, and the Local Rules of this Court. WHEREFORE, the Petitioner prays for admission to practice before the United States District Court for the Eastern District of North Carolina. This day of , 20 . (Signature of Petitioner) Law Firm (if applicable): Office Address: Telephone Number: (Office) (Residence) E-Mail Address: Fax Number: Date of NC Bar Admission: NC Bar Number: We, the undersigned members in good standing of the bar of this Court, do hereby certify that the above named Petitioner is of good moral character and professional reputation and meets the requirements for admission to the bar of this Court. (1) Attorney at Law (Signature) Address Date Printed Name NC Bar Number (2) Attorney at Law (Signature) Address Date Printed Name NC Bar Number ORDER It appearing to the Court that the above-named Petitioner is a member in good standing of the bar of the Supreme Court of North Carolina and has studied the Federal Rules of Civil and Criminal Procedure, the Federal Rules of Evidence, and the Local Rules of this Court; and is of good moral character and professional reputation; NOW, THEREFORE, IT IS ORDERED by the Court that the Petitioner be, and is hereby, admitted to all the privileges of an attorney and counselor of the United States District Court for the Eastern District of North Carolina. Let the certificate issue. This day of , 20 . U.S. District/Magistrate/Bankruptcy Judge FEE: $211.00 Revised American LegalNet, Inc. www.FormsWorkFlow.com Indicate the types of cases you are willing to accept:Indicate the capacity in which you are willing to provide representation: American LegalNet, Inc. www.FormsWorkFlow.com Indicate potential conflicts that may affect your ability to provide representation, including but not limited to your representation of any governmental entities: Indicate whether you are interested in contributing pro bono services (1) as a mentor, experienced in federal court practice,to an attorney providing pro bono servicesor (2) under the mentorship of an experienced federal court practitioner:I aminterested in mentoring an attorney providing pro bonoservices:I am interested in providing pro bono services with the assistance of a mentor:By signing below, I certify that I am a member in good standing of the bar of the United States District Court of the Eastern District of North Carolina. American LegalNet, Inc. www.FormsWorkFlow.com