FORM 21. Application for Admission to the Bar Form 21 Rev. 03/16 UNITED STATES COURT OF APPEALS FOR THE FEDERAL CIRCUIT APPLICATION FOR ADMISSION TO THE BAR I (print name), Street/P.O. Box City/State/Zip/Phone Firm name and e-mail address do hereby apply for admission to the bar of the United States Court of Appeals for the Federal Circuit. My personal statement showing my eligibility for membership is as follows: I am admitted to practice before the highest court of these states (attach extra page if necessary). State Court/Date of Admission (month and year) State Bar Number (if any) I am admitted to practice before these federal courts (attach extra page if necessary): Federal Court/Date of Admission (month and year) Federal Bar Number (if any) I certify that I am not presently subject to discipline by another court. I will inform this court within 30 days of any disciplinary action taken against me by any court and will furnish the court with copies of relevant court orders and I will inform the court if any bar application is denied. , whose mailing address is: Date of Birth Signature of Applicant MOTION OF SPONSOR (The motion of a sponsoring member of the bar is not required if the applicant attaches a certificate of good standing as described in Federal Circuit Rule 46(b).) I, , certify that I am member of the bar of this court in good standing. I am satisfied that the applicant possesses the qualification set forth by the Federal Rules of Appellate Procedure 46 (a) and hereby move the admission of the above attorney. Date: Signature of sponsor: OATH OF ADMISSION (Execute the oath unless arrangements have been made to have the oath administered in open court) I, , do solemnly swear (or affirm) that I will comport myself as an attorney and counselor of this court, uprightly and in accordance with the law, and that I will support the Constitution of the United States. Date of Birth Subscribed and sworn before me on this date: Signature of Notary: [Seal] Signature of Applicant My commission expires on this date: American LegalNet, Inc. www.FormsWorkFlow.com