Revised February 18, 2009 APPLICATION FOR ADMISSION TO PRACTICE LAW IN THE WESTERN DISTRICT OF VIRIGINIA I, ______________________________, age _________, hereby make application for admission to practice law in your Honor's Court. On _________________________, Date of Admission to VA Bar I was admitted to practice law in this state by the Commonwealth of Virginia. RESPECTFULLY SUBMITTED: __________________________ Signature of Applicant _________________________________ Full Printed Name of Applicant __________________________ Social Security Number _________________________________ Virginia State Bar ID Number _________________________________ _________________________________ _________________________________ Firm Mailing Address _________________________________ Firm Telephone We, the undersigned members of the bar of this Court, do hereby certify that we are acquainted with the above applicant, and that he/she is a person of good character and ethical conduct. __________________________ _____________________________ Signature of Admitted Attorney Printed Name of Admitted Attorney __________________________ Signature of Admitted Attorney _____________________________ Printed Name of Admitted Attorney PLEASE DO NOT SUBMIT ANY FEES WITH THIS APPLICATION. Fees for admission ($176) and/or a Certificate of Good Standing ($18) will be collected immediately following your admission to the Court. Upon verification of the information provided above, the Clerk's Office will call you to schedule an appointment for you to be sworn in. American LegalNet, Inc. www.FormsWorkFlow.com