Dues And Cle Sempass Statement

For official OCBA use

Dues & CLE Sempass Statement

Amount: $ ______________ Check #:

______________

For the year __________

Date Received: __________

ONEIDA COUNTY BAR ASSOCIATION 258 Genesee Street, Suite 302 Utica, New York 13502 Tel: 315-724-4901 Fax: 315-724-6010

Your Name:

__________________________________________________________

Firm Name & Address:

__________________________________________________________ __________________________________________________________ __________________________________________________________

Telephone:

Business: _____________________ Fax: _____________________

E-mail Address:

__________________________________________________________

Date Admitted to New York Bar (Month, Day and Year): __________________________________ Circle one:

A. i

Active Member

Associate Member

50 Year Lawyer/Newly Admitted

Retired

Active Members who have been admitted to practice for more than one (1) year as of January 1, of __________ ......................................... $160.00

ii Associate Members who have been admitted to practice for more than one (1) year as of January 1, of __________ (Associate Members live and practice outside Oneida County) ................................... $80.00 iii Honorary Members who have been admitted to practice 1) Less than (1) full year as of January 1, of __________ 2) More than 50 Years .................................................................................................. $0 iv Retired Members over 70 years of age who no longer practice law (must be registered with the State of New York as fully retired) .................................. $25.00

Dues & CLE Sempass Statement (page 2)

B.

OCBA CLE SEMPASS (A Sempass is good for entire year of __________ ................... $160.00

Total of sections A & B: $__________

Preferred Committee Assignment: (Please place check mark(s) by preference.) The Committee lists are made up by the President in February. Please do not sign up for a committee just to have your name on the list, we need people who are willing to give a few hours of their time during the year. ___ Program ___ Grievance & Ethics ___ Fee Disputes ___ Pro Bono ___ Continuing Legal Education ___ Courts & Judiciary ___ District & State Bar Liaison ___ Family & Domestic Relations ___ Lawyers Assistance ___ Real Property ___ Estates, Trusts & Elder Law ___ Public Information & Education

Please print out this form and mail it to OCBA at the address above.