Your browser does not support javascript. This is required for using the requested form.
RCBA Affiliate Membership Application
If you are a Paralegal, Business Professional, Attorney Service Provider, Legal Secretary, or a Law Librarian, you are invited to join us as an "Affiliate Member."
Riverside County Bar Association; 4129 Main Street Suite 100; Riverside CA 92501
1.
mm/dd/yyyy
2.
Name *
3.
Title
4.
Date of Birth
5.
Business Name *
6.
Nature of Business *
7.
Office address (include suite # ) *
8.
If different, mailing address / P.O.Box (include zip)
9.
Work phone *
10.
Work fax
11.
Alternate phone
(home or cell)
12.
Email
13.
If you are a Paralegal, please provide the name, bar number, and address of your supervising attorney.
14.
Spouse's name
15.
Residence address:
16.
Reasons for your interest in RCBA:
17.
Have you been a party to any criminal litigation or subjected to any disciplinary action? *
Yes
No
18.
If Yes. Please explain:
19.
Referred/Sponsored by
20.
Dues *
$150 Business Professional
$150 Paralegal
$150 Attorney Service Provider
$ 50 Legal Secretary
$ 50 Law Librarian
21.
Payment Method: (note: membership is not active until payment is received)
PayPal accepts:
*
I will pay online by SECURE PayPal (you will be transferred to our PayPal Cashier)
I will send my check today to RCBA --4129 Main Street-- Riverside, CA 92501
I will pay by credit card (call 951 682 1015)
Please invoice me; I will pay by credit card or check
* = Input is required
This form was created at
www.formdesk.com