Name of law firm: county: telephone: fax: contact lawyer: county: telephone: fax: contact lawyer:

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1 1. Law Firm Union Plus Legal Service APPLICATION FOR THE ATTORNEY PANEL You may apply in letter form if that is more convenient, but please number each answer and complete all items. Be sure to read the Notes on page 4. Name of law firm: Number of lawyers in the firm: Number of support staff (in full time equivalents): How many lawyers in the firm are interested in providing services to Union Privilege members? 2. Office(s) Main office - complete street address: county: contact lawyer: Branch office 1 - complete street address: county: contact lawyer: Branch office 2 - complete street address: county: contact lawyer: _ (for additional branch offices attach a separate sheet) Union Privilege 1100 First St., NE Suite 850 Washington, DC Phone (202) Fax (202)

2 3. Lawyer(s) Please complete this section for each participating lawyer. Attach additional sheets if necessary. Lawyer 1 - name: _ years of practice in your present community: total years of legal experience: law school from which degree received: year: undergraduate school and degree other graduate education: bar admissions (state and year): certified practice specialties: Do you have any grievances pending? yes (attach explanation) no Fluency in languages other than English: Lawyer 2 - name: years of practice in your present community: total years of legal experience law school from which degree received: year: undergraduate school and degree other graduate education: bar admissions (state and year): certified practice specialties: Do you have any grievances pending? yes (attach explanation) no Fluency in languages other than English: Lawyer 3 - name: _ years of practice in your present community: total years of legal experience law school from which degree received: year: undergraduate school and degree other graduate education: bar admissions (state and year): certified practice specialties: 2

3 Do you have any grievances pending? yes (attach explanation) no Fluency in languages other than English: 4. Areas of Practice What percentage of your practice is devoted to the following areas of law? If more than three lawyers will participate, please combine the percentages for all lawyers in one column. Lawyer 1/Firm Lawyer 2 Lawyer 3 family % % % wills and probate -estate planning ( ) ( ) ( ) housing and real estate consumer -bankruptcy ( ) ( ) ( ) criminal -felony ( ) ( ) ( ) -juvenile ( ) ( ) ( ) immigration employment personal injury (plaintiff) -workers compensation ( ) ( ) ( ) -medical malpractice ( ) ( ) ( ) other (specify) TOTAL 100% 100% 100% Please use this space if necessary to explain or clarify the above figures: 5. Fees regular UPLS (=30% discount) regular UPLS (=30% discount) Hourly $ $ Fixed simple will $ $ uncontested divorce Contingent (see note RE discount) home purchase personal injury % % Ch.7 bankruptcy drunk driving defense workers comp (1st offense) Other Other 3

4 Do you bill separately for paralegal time? yes regular $ /hour UPLS $ /hour no Please check if you bill separately for: long distance phone or fax copies deliveries How do you normally bill lawyer travel time? regular hourly rate reduced hourly rate hourly rate plus expenses expenses only other Notes: _ 6. Insurance Attach a copy of the face sheet of your professional liability insurance policy. 7. Unions Please describe any present or past association with or work for AFL-CIO unions: Do you ever represent management in labor-management negotiations or other labor relations matters? yes (attach detailed explanation) no 8. Legal Services Plans Please list any other legal services plans you are presently serving: 9. Miscellaneous Do you have evening or Saturday office hours? yes, regularly yes, by appointment not usually What procedure do you have for handling legal emergencies? Please indicate any foreign languages that any support staff speak fluently enough to act as interpreter for you: Please check if you: accept credit cards have a marketing brochure publish a client newsletter conduct seminars use information handouts (e.g. bar pamphlets), do other client outreach (please explain) maintain a website (address: ) Signature: I certify that the information in this application is true and correct. Signature Date You are not a panel attorney until you receive a signed copy of your contract. Your fee will be returned if your application is not approved. Notes: The numbers below correspond to the application form. 1. Law firm. Not all lawyers in the firm need participate. There is little point, for example, in a lawyer being on the panel who does nothing but labor law or commercial real estate. You may refer members to any lawyer in your firm provided the lawyer abides by the UP fee schedule for the firm and provides all free services, etc. as if the lawyer were participating. 2. Offices. The contact lawyer will be listed in the Union Privilege directory and is the person most callers will ask for. The same contact lawyer should not normally be listed for more than two offices. A branch office qualifies for a listing if it is a separate physical location at which you regularly meet with clients. It need not be staffed full time or have a separate phone number. 4

5 3. Background. Please list a foreign language only if you are fluent enough to interview a prospective client in that language. This will be noted in the directory. There is space in section 9 to mention the language fluencies of support staff, which also qualify for listing in the directory. 4. Practice. If more than three lawyers wish to participate, please combine practice percentages in one column. The total should equal 100% for each column. Any percentages shown in subcategories should be included in the figure shown for the main category, e.g., if 20% of your practice concerns wills and probate and half of that is estate planning, "20%" should appear on the wills and probate line and "10%" on the estate planning line. Use the extra space to provide a clearer picture of your practice if the percentages shown are misleading in some way. 5. Fees. All fees except contingent fees must reflect a 30% discount for UPLS members. No discount is required on contingent fees except from personal injury specialists. You must show an hourly rate if you have one. If you have a range of hourly rates, indicate what affects the rate, e.g., attorney used, type of case, in office v. in court. Show fixed fees only if you use them. Do not include filing fees or other court costs. Attach your full fee schedule in addition, if you wish, but be sure to indicate whether it is pre or post discount. 6. You must have professional liability insurance. Mail your completed application, contract, $99 participation fee, (payable to "Union Plus Legal Service") evidence of liability insurance and fee schedule to: Union Plus Legal Service 1100 First Street, NE, Suite 850 Washington, DC ### 5