ARNP Membership Form

Name of Law Firm *
Attorney (Member) Name *
Type the name of the MEMBER in this field, your name.
Attorney Biography
Optional but recommended field
Bar Number *
Firm Address: *
Office County *
Phone Number: *
Fax Number: *
Email Address *
Type the email address that needs to be listed for your firm in this field.
Website *
Type NA if you do not have a website
Licensed in (States) *
List each state that you are licensed to practice law in here.
Counties Covered *
County Membership: Our county member ship includes up to five counties in the same state for $250.00, type five counties wanted in this field. You can be listed under additional counties for $25.00 each or select our state wide member ship.

State wide Membership: Our state wide membership is $350.00, type state wide if you want to be a state wide member, you will be listed under your address county as well as our state wide section, located above the county section.
Areas of Practice *
Client Message *
Type a message for prospect clients in this field, an attention grabber or slogan.
Attorney Photo
Optional
Signature (type name): *
Date Completed (type date): *
Email (for confirmation) *
Type the email address for the membership confirmation in this field.