LRIS MEMBER DEMOGRAPHICS and PANEL SELECTIONS

Lawyer Referral &

Information Service (LRIS)

A Public Service of the State Bar of Nevada www.nvbar.org

Membership

Application

May 2015

LRIS MEMBER DEMOGRAPHICS and PANEL SELECTIONS

LRIS Membership Application

Nevada Admit year

Bar Number

Firm Size

Name

Firm Name

Phone

E-mail address

Errors & Omissions Insurance Requirements

In agreeing to participate on the Lawyer Referral & Information Service, I certify that I have professional

liability insurance of $250,000 per claim with $500,000 aggregate limits, as provided in Article three, Section

one of the LRIS Statement of Standards and Rules. Furthermore, if my insurance is cancelled or not re-

newed I will notify LRIS immediately. I understand I will not receive referrals if I cease to carry professional

liability insurance. A copy of the Declaration Sheet of my insurance policy is enclosed with my application.

LRIS Important Information

Completed Application Checklist: Please use the checklist below to ensure your application is

complete:

I was admitted to practice in Nevada on: / / Graduated from (name of Law School)

Name of your staff contact (I.e. secretary, assistant, etc.)

Are you a Solo Practitioner? If not please indicate Firm size

My hourly rate is $____________. (Note: LRIS will not quote fees

to potential clients. This information is used for the sole purpose

of accurately referring the caller to the panel member).

I was first licensed to practice law on: / /

Copy of “Declaration Page” from E&O Insurance Policy

$50.00 Payment for Annual Membership Dues

Copy of Resume or curriculum vitae

Completed & signed Reduced Fee Panel Application

Completed & signed Experience Panel Application

Completed & signed Full Fee Panel Application

Please indicate below what type of application this is.

New Membership

Renewal of Membership

Panel Changes only

Please mail completed packet to:

State Bar of Nevada 3100 W. Charleston Blvd.

Las Vegas, NV 89102

Signature

Method of $50.00 Fee payment

Address

Initials: ____________

Fax

PLEASE RETURN SIGNED

STATEMENT OF STANDARDS AND RULES

WITH APPLICATION

LRIS MEMBER DEMOGRAPHICS and PANEL SELECTIONS

States you are licensed to practice in and where you would like referrals:

Your signature indicates your understanding that the LRIS program will attempt to refer to you only persons who have indicated problems in the panels/areas of law you have selected, and that you believe you are competent in those areas that you have selected. Please note that the LRIS staff is only able to do a limited screening before a referral is made. Your signature also indicates that you are familiar with the LRIS Statement of Standards and Rules and you agree to abide by those Rules. The Statement of Standards and Rules is forwarded to all new members when they join the Lawyer Referral & Information Service. If you need a new copy, please contact the LRIS staff at 702-382-2200. The Lawyer Referral & Information Service is a public service program of the State Bar of Nevada.

Signature Name (Please Print) Date

Your signature indicates that you have read the application in its entirety and that the facts stated in it are true and correct to the best of your knowledge and belief.

__Stateline __Sun Valley __Tonopah __Wendover __Winnemucca __Yerington __Zephyr Cove __Other

State ____________ State ____________

State ____________ State ____________

Please indicate what languages are spoken in your office:

Language: _____________________ Language: _______________________

Language: _____________________ Language: _______________________

Are you able to assist a Spanish speaking client? Yes ____ No ____

OFFICE INFORMATION

___Handicap Accessible ___Home Visits

___Weekend/Evening Appointments

Locations:

Please select the cities you’d like to receive referrals from:

__Battle Mountain __Beatty __Boulder City __Carson City __Dayton __Elko __Ely __Eureka __Fallon

__Fernley __Gardnerville __Hawthorne __Incline Village __Jean __Lake Tahoe __Las Vegas/Henderson/ North Las Vegas

__Laughlin __Lovelock __Mesquite __Minden __Pahrump __Reno/Sparks __Searchlight __Silver Springs

LRIS MEMBER DEMOGRAPHICS and PANEL SELECTIONS

Signature ________________________ Name (print)________________________ Date ________

Separate application needed for Experience Panels in

1) Medical Malpractice, Wrongful Death, Products Liability;

2) Category A & B Felonies;

3) Bankruptcy;

4) Family Law case types not listed on this application

Administrative Law

__ Department of Labor __ Native American/Tribal Matters __ Military Matters __ Public Utilities __ State/Local Agencies __ Veteran’s Administration __ Federal Agencies __ Licensing Boards __ Department of Motor Vehicles

Appellate Law

__ Civil __ Criminal

Civil Rights

__ ADA __ Housing Issues __ Mental Health __ Police Misconduct __ Prisoner’s Rights __ Discrimination/Harassment (non-employ)

Collections

__ Creditor __ Debtor __ Business Representation

Consumer Law

__ Lemon Law/Repairs __ Contracts (retail/other) __ Credit Issues (Credit Card, etc.) __ Warranty Matters __ Repossessions __ Consumer Fraud/Protection __ Education Loans/Rights/Non-payment

Corporate/Business

__ Licensing __ E-Commerce __ Non-Profit Organizations __ Contracts __ Securities __ Incorporation __ LLC/LLP __ Partnerships __ Sole Proprietorships __ Antitrust __ Entertainment Law matters __ Franchise __ Banking Matters (Rules/Laws)

Criminal Law

__ Federal __ Felony (Category C, D, E only) __ Misdemeanor __ Traffic Matters __ DUI __ Expungements __ Juvenile __ Prisoners (Bail, Pleadings)

Your signature indicates your understanding that the LRIS program will attempt to refer to you only persons who have indicated problems in the panels/areas of law you have selected, and that you believe you are competent in those areas that you have se-lected. Please note that the LRIS staff is only able to do a limited screening before a referral is made.

Please check the categories below which apply to your practice.

____________________________________________________________________________________________

LRIS MEMBER DEMOGRAPHICS and PANEL SELECTIONS

Signature_______________________ Name (print)______________________ __ Date__________

Please check the categories below which apply to your practice.

____________________________________________________________________________________________

Education

__ Special Education/Special Needs __ Student Rights __ Teacher Rights __ Board Disputes

Elder Law

__ Elder Law __ Nursing Home Issues

Employment Law

__ Employer Representation __ Federal Employees __ Pensions __ Employment Contracts __ Employee Benefits __ Union Issues __ Sexual Harassment __ Discrimination (Age, Gender, Race) __ Unemployment __ Wrongful Termination __ ERISA __ Drug Testing __ ADA __ Defamation __ Family Medical Leave Act (FMLA) __ Payroll Issues __ State Employees

Estate Planning

__ Contested Matters __ Guardianships __ Probate __ Trusts __ Wills

Family Law

__ Uncontested Custody __ Uncontested Divorce __ Uncontested Guardianship __ Child Support __ Spousal Support __ Annulment __ Visitation __ Paternity __ Grandparents/Stepparent Rights __ Property Settlements — assets under $25,000 (i.e. household items, personal belongings) __ Name Change __ Protection/Restraining Orders __ Emancipation __ Stepparent Adoption

Gaming

__ Markers __ Licensing __ Nevada Gaming Commission

Immigration & Naturalization

__ Deportation __ Legalization __ Miscellaneous __ Visa/Status

Insurance

__ Bad Faith __ Coverage __ Automobile __ Health __ Short/Long Term Disability __ Professional Malpractice

Your signature indicates your understanding that the LRIS program will attempt to refer to you only persons who have indicated problems in the panels/areas of law you have selected, and that you believe you are competent in those areas that you have se-lected. Please note that the LRIS staff is only able to do a limited screening before a referral is made.

LRIS MEMBER DEMOGRAPHICS and PANEL SELECTIONS

Signature_______________________ Name (print)______________________ __ Date__________

Please check the categories below which apply to your practice.

_____________________________________________________________________________________________

Intellectual Property

__ Copyright __ Patents __ Trademark __ Computer/Internet

Natural Resource

__ Environmental Matters __ Mining __ Oil & Gas __ Water

Negligence/Tort Law

__ Property Damage __ Slip & Fall __ Auto Accidents—Plaintiff __ Auto Accidents—Defense __ Animal Negligence __ Identity Theft __ Assault & Battery __ Defamation __ Toxic Tort __ Dental Malpractice __ Food Poisoning __ Legal Malpractice __ Personal Injury—Defense __ Personal Injury—Plaintiff __ Invasion of Privacy __ False Imprisonment __ Infliction of Emotional Distress __ Trespass to Land __ Mold __ General Negligence __ Nuisance __ Sexual Harassment

Real Estate

__ Banking/Predatory Lending __ Commercial Eviction—Defense __ Commercial Lease—Defense

Real Estate (cont’d)

__ Commercial Purchase/Sale __ Commercial Eviction—Plaintiff __ Commercial Lease—Plaintiff __ Condo Associations/HOA — Defense of __ Condo Associations/HOA — Complaints against __ Construction Defect __ Contractor Disputes __ Construction Liens __ Eminent Domain __ Foreclosures __ General Construction __ Loan Modification __ Mechanics Liens __ Realtor Negligence __ Residential Eviction—Tenant __ Residential Lease—Tenant __ Residential Eviction—Landlord __ Residential Lease—Landlord __ Residential Purchase/Sale __ Zoning

Social Security

__ Disability __ Retirement __ Medicare/Medicaid __ SSI

Tax Law

__ Commercial/Business Tax Matters __ Tax Liens __ Personal Tax Matters

Workers Compensation

__ Federal Employees __ Employee Representation __ Employer Representation __ State Employees

Your signature indicates your understanding that the LRIS program will attempt to refer to you only persons who have indicated problems in the panels/areas of law you have selected, and that you believe you are competent in those areas that you have se-lected. Please note that the LRIS staff is only able to do a limited screening before a referral is made.

LRIS MEMBER DEMOGRAPHICS and PANEL SELECTIONS

Experience Panels Are Available in the Following Areas:

Medical Malpractice, Wrongful Death, Products Liability

Category A & B Felonies

Bankruptcy

Family Law:

Contested Custody Contested Divorce

Contested Guardianship Child Protective Services

Termination of Parental Rights Prenuptial Agreements

Parental Kidnapping Property Settlements (assets over $25,000)

Appeals Adoption (Non-familial)

If you’re interested in any of these experience panels, please contact LRIS for a separate application.

Your signature indicates your understanding that the LRIS program will attempt to refer to you only persons who have indicated problems in the panels/areas of law you have selected, and that you believe you are competent in those areas that you have se-lected. Please note that the LRIS staff is only able to do a limited screening before a referral is made.