UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF OHIO ELECTRONIC FILING ATTORNEY REGISTRATION FORM This form is used to register for an account on the Northern District of Ohio Electronic Filing System (the system). Registered attorneys will have privileges to electronically submit documents and to view the electronic docket sheets and documents. Once your registration is complete, a user id and password will be sent to you via email. Please call the Electronic Filing Help Desk at 1-800-355-8498 with any questions. SECTION I PLEASE TYPE Mr. / Mrs. / Ms. (circle one) First Name: ___________________________________________ Middle Name: _________________________________ Last Name: ___________________________________ If appropriate circle one: Senior / Junior / II / III Firm Name: __________________________________________________________________________________________ Address: ____________________________________________________________________________________________ ____________________________________________________________________________________________ City:__________________________________State:_____________________Zip Code:____________________ Have you relocated to this address within the past year? Yes _____ No _____ Voice Telephone Number: (_______)________________________ Fax Number: (________)________________________ Internet Mail Address: _________________________________________________________________________________ SECTION II Attorneys seeking to file documents electronically must be admitted to practice in the United States District Court for the Northern District of Ohio pursuant to LR 83.5 and LCrR 57.5. Please complete which applies. Highest state court admitted: _______________________________ Bar ID Number: _______________________ Are you currently in good standing? Yes _____ No _____ Date admitted to practice in this Court: ___________________________ Attorney for the United States? Yes _____ No _____ Date Applicant’s Personal Statement & Oath submitted pursuant to LR 83.5(k) & LCrR 57.5(k): _________________________ Date motion to be admitted pro hac vice granted: _______________________in case number: _________________________ Pro hac vice admission fee receipt number: __________________________________________________________ If Attorney of Record in an MDL action in this court indicate case number: ________________________________________ A PACER account is required to view documents on the CM/ECF system. For information regarding PACER call 1-800-676-6856 or visit the website at www.pacer.psc.uscourts.gov I agree to abide by all Court rules, orders and policies and procedures governing the use of the electronic filing system and consent to receiving notice of filings pursuant to Fed. R. Civ. P. 5(b) and 77(d) and Fed. R. Crim. P. 49(b)-(d) via the Court’s electronic filing system. The combination of user id and password will serve as the signature of the attorney filing the documents. Attorneys must protect the security of their password and immediately notify the Court if they learn that their password has been compromised by an unauthorized user. _________________________________________ Signature of Applicant Submit completed Registration Form to: ______________________________ Date Geri M. Smith, Clerk United States District Court Attention: Electronic Filing System Registration 801 West Superior Avenue Cleveland, OH 44113-1830 Revised 7/11/08 American LegalNet, Inc. www.FormsWorkflow.com