UNITED STATES DISTRICT COURT002 DISTRICT OF OREGON002 In the Matter of the Application of (full name of applicant)002 (name of applicant as it will appear on filings)002 for Special Temporary MDL Admission to the Bar of the United States District Court for the District of Oregon Application for Special Temporary MDL Admission and CM/ECF Registration I am applying for special temporary admission to the Bar of the United States District Court for the District of Oregon for purposes of participating in , a case that has been transferred to the District of Oregon pursuant to 28 U.S.C. 247 1407 (Multi-District Litigation). In support of this application, I certify that: 1) I am an active member in good standing with the State Bar; and 2) that I have read and am familiar with the Federal Rules of Evidence, the Federal Rules of Civil and Criminal Procedure, the Local Rules of this Court, and this Court's Statement of Professionalism. I understand that my admission to the Bar of the United States District Court for the District of Oregon is solely for the purpose of litigating in the above matter and will be terminated upon the conclusion of the matter. (1) PERSONAL DATA: Name: (Last Name) Agency affiliation: (First Name) (MI) (Suffix) Mailing address: City: State: Zip: Phone number: Fax number: Business e-mail address: U.S. District Court Oregon [Rev. 03/2018] Application for Special Admission for MDL Purposes Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com (2)002 EDUCATION: (a)003 Undergraduate School: City: State: Year Graduated: Degree(s): (4) (b)003 Graduate School:City: State: Year Graduated: Degree(s): (c)003 Law School: City: State: Year Graduated: Degree(s): (3) BAR ADMISSION INFORMATION: (a)003 State bar admission(s), date(s) of admission, and bar number(s): (b)003 Other federal court admission(s) and date(s) of admission: CERTIFICATION OF DISCIPLINARY ACTIONS: I am not now, nor have I ever been subject to any disciplinary action by any state or federal bar association. I am now or have been subject to disciplinary action by a state or federal bar association. (See attached letter of explanation.) CERTIFICATION OF PROFESSIONAL LIABILITY INSURANCE: I have professional liability insurance, or financial responsibility equivalent to liability insurance, that will apply and remain in force for the duration of the case, including any appeal proceedings. (5) U.S. District Court Oregon003 Application for Special Admission for MDL Purposes [Rev. 03/2018]003 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com (6) REPRESENTATION STATEMENT: I represent the following party(s) in this case: (7) CM/ECF REGISTRATION: I acknowledge that I will become a registered user of the Court's case management and electronic case filing system (CM/ECF) upon approval of this application, and I consent to electronic service pursuant to Fed. R. Civ. P. 5(b)(2)(E) and the Local Rules of the District of Oregon. DATED: . (Signature) U.S. District Court Oregon Application for Special Admission for MDL Purposes [Rev. 03/2018] Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com