UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF OKLAHOMA ) ) ) ) ) ) ) ) ) ) vs. Plaintiff(s) Case No. ________________ Defendant(s) REQUEST FOR ADMISSION PRO HAC VICE I hereby request admission to the Bar of this Court PRO HAC VICE in support of which I represent that the answers to the following questions are complete, true and correct: 1. 2. 3. Full name: State bar membership number: Business address, telephone and fax numbers: 4. List all state and federal courts or bar associations in which you are a member "in good standing" to practice law: 5. Have you been denied admission, disbarred, suspended from practice, reprimanded, denied "in good standing" status, or otherwise disciplined by any court, bar association, grievance committee or administrative body? Have any proceedings which could lead to any such disciplinary action been instituted against you in any such bodies? (Please attach a statement explaining any "YES" answers to questions 5 or 6.) Are you familiar with the Federal Rules of Evidence, the Federal Rules of Civil or Criminal Procedure (as applicable to this case) and the local rules of this court? A check for $50 should be made payable to the U.S. District Court Clerk. (United States Government Attorneys are exempted from paying this fee.) DATED this ________ day of _____________________________. G Yes G No 6. G Yes G No 7. G Yes G No 005/rvsd 06-04 Signature of Applicant American LegalNet, Inc. www.FormsWorkFlow.com