Register to be a Pro Bono volunteer

Suffolk County Bar Association requests that you to complete the following form so that we may register you in the volunteer Pro Bono Project. Please note that the information contained herein is transmitted to us through a secure site. Fields marked with an "*" are required. If you have any questions you may contact us: (631) 234-5511 (ext. 231), or E-Mail us at probono@scba.org

Full Name (first & last)(*)

Please let us know your name.

Firm Name (if any)

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E-mail Address(*)

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Address where we can contact you(*)

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City(*)

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State(*)

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Zip(*)

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Work Phone(*)

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Home Phone

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Cell Phone

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Fax

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Fill out the following 3 fields only if you are an attorney or retired attorney.

Date admitted to practice law in New York State

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Department of Admission

First Dept.Second Dept.Third Dept.Fourth Dept. Invalid Input

Attorney Certification

I certify that I am an attorney in good standing, admitted to practice in the State of New York -OR- I am a retired attorney who has practiced law in the State of New York for five of the last ten years. Invalid Input

Non Attorney Volunteers

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Languages in addition to English

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Disabled Accessibility

My office is accessible to the disabled. Invalid Input

Membership Status(*)

SCBA Attorney MemberSCBA Student MemberNon-Member AttorneyNon Member Invalid Input

I cannot provide direct representation, but please sign me up for the following:

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I cannot volunteer my services, but wish to support the PBP with a tax-deductible contribution in the amount of

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The SCBA is temporarily not processing credit card information on line. AFTER SUBMITTING THIS FORM PLEASE CALL THE SCBA AT 631-234-5511 AND GIVE YOUR CREDIT CARD INFORMATION BY PHONE. THANK YOU.

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Register to be a Pro Bono volunteer

Register to be a Pro Bono Volunteer

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