Form 21 FORM 21. Application for Admission to the Bar United States Court of Appeals for the Federal Circuit APPLICATION FOR ADMISSION TO THE BAR I (print name),_____________________________________________________, whose mailing address is: Street/P.O. Box _________________________________________________________________________ City/State/Zip/Phone _____________________________________________________________________ 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) ______________________________________________ I am admitted to practice before these federal courts (attach extra page if necessary): Federal Court/Date of Admission (month and year) ____________________________________________ 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. _____________________________________ 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 Fed. Cir. R. 46(b).) I (print name), ____________________________________, a member of the bar of this court, do 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. _____________________________________ Signature of Applicant Subscribed and sworn to before me on this date: _______________________ My commission expires on this date: ____________________________Signature of Notary: _________________________________ [Seal] 142 American LegalNet, Inc. www.FormsWorkflow.com Form 21 FORM 21. Application for Admission to the Bar (continued) INSTRUCTIONS FOR APPLYING FOR ADMISSION TO THE BAR OF THE UNITED STATES COURT OF APPEALS FOR THE FEDERAL CIRCUIT Fill out the application on the reverse side. Print your name clearly on the first line. Your name as printed will be the name that appears on the court’s attorney roster and on the certificate of admission. You may submit a completed admission form accompanied by a certificate of good standing from one of the courts enumerated in Fed. R. App. P. 46(a) or Fed. Cir. R. 46(a) (the certificate must be dated within 30 days of the motion for admission and must bear the seal of the issuing court) or you may submit a completed admission form and have a member of the bar move for your admission in the space provided on the form. Fed. Cir. R. 46(b) sets forth the admissions procedures fully. The prescribed fee for admission is $200. The application must include a check in that amount payable to the Clerk of Court. The application and check should be sent to: Clerk of Court, United States Court of Appeals for the Federal Circuit, 717 Madison Place, NW, Washington, DC 20439. FOR CLERK’S USE ONLY Fee Paid: __________ yes __________ no Date Paid: ___________________ Admitted On: ___________________ _________________________________ Signature of Clerk or Deputy Clerk 143 American LegalNet, Inc. www.FormsWorkflow.com