Pinellas County Trial Lawyers Association

PINELLAS COUNTY TRIAL LAWYERS ASSOCIATION

To Join
PINELLAS COUNTY TRIAL LAWYERS ASSOCIATION

RENEWAL / NEW MEMBER APPLICATION

Annual Membership Dues are $100.00
Payable to: "Pinellas County Trial Lawyers Association"
Mail to: Robert L. Chapman
PCTLA Treasurer
Battaglia, Ross, Dicus & Wein, P.A.
980 Tyrone Blvd
St. Petersburg, FL 33710

DUES AND MEMBERSHIP FORM

Dear Current or Prospective Member:

Please take a moment to complete the following renewal or new membership form. This information will be used to compile a Member Referral Directory. Please forward this completed form along with your membership or renewal fee in the amount of $100.00 payable to PCTLA and mail to: Robert L. Chapman, PCTLA Treasurer, c/o Battaglia, Ross, Dicus & Wein, P.A., 980 Tyrone Blvd, St. Petersburg, FL 33710. Meetings are the third Thursday of each month at Antonio's Pasta Grill on Ulmerton Road, Clearwater. Notices for monthly meeting shall be furnished to your e-mail address. See you at the next meeting.

NAME:____________________________________________________________

FIRM NAME:_______________________________________________________

ADDRESS:_________________________________________________________

CITY: __________________________ STATE _______ ZIP CODE: _______

TELEPHONE:_____________________ FAX:____________________________

EMAIL ADDRESS:____________________________________________________

WEBSITE ADDRESS:__________________________________________________

PCTLA MEMBER SINCE:_____________________ NEW MEMBER:___________

AREAS OF PRACTICE:______________________________________________

__________________________________________________________________

ADDITIONAL INFORMATION: ___________________________________________

Enclosed $100.00 for dues. TOTAL $____________

For Inquiries, please e-mail us.

Nathan Suedmeyer (nathan@larsonpatentlaw.com)
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