Pinellas County Trial Lawyers Association

PINELLAS COUNTY TRIAL LAWYERS ASSOCIATION

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PINELLAS COUNTY
TRIAL LAWYERS ASSOCIATION

2008 RENEWAL / NEW MEMBER APPLICATION

2008 Membership Dues are $100.00
payable to "Pinellas County Trial Lawyers Association"
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 Johnny Drizis, Treasurer, PCTLA 2435 U.S. Highway 19, Holiday, Florida 34691-3909. 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.

Garry Potts (www.gpottslaw.com)
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