San Diego County Bar Association Board/Commissions Interest Form

Please complete the following information and press the "Submit" button at the bottom of the form. NOTE: For those who prefer not to use a firm address, please use your home address and contact information, do not leave fields with an asterisk (*) blank.

Contact Information
Full Name*
Firm Name*
Firm Address *
 Suite or Floor
City *

 Zip Code *
Residence Address *
 Appartment
City *
 Zip Code *
Telephone (work) *
 Fax (work)

E-mail *
State Bar Membership Information
CA State Bar Number *
 Date Admitted *
By submitting this application I certify that I am an attorney licensed to practice law in the State of California with no sanctions or reprimands in any jurisdiction.
I hereby certify that I maintain professional liability insurance.
  I am prepared to file an annual Statement of Economic Interest (SEI), if required for the Board or Commission to which I might be appointed (approximately half of the boards of teh City of San Diego require an SEI, and the number is likely to increase).
  I live in the City of San Diego.
I am interested in serving on a city/county board, commission or committee in the following issue areas (check as many as appropriate)

Construction/Land Use
Disabilities
Economic Development
Environment
Historic resources

 Housing
Health/Medical
International
Labor/Employment
Public Safety/Law Enforcement

Recreation
Transportation
Water
Youth
Other (please list):