First Name:
Last Name:
Organization/Firm:
Address:
City:
State:	--- Select a State --- AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware DC - District of Columbia FL - Florida GA - Georgia HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VT - Vermont VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming OT - Other
Zip Code:
E-mail Address:
Daytime Telephone:
Bar Admission Date:
Gender:	Male      Female
Goal IX (check all that apply):
	African American
	Asian
	Caucasian
	Hispanic
	Native American
	Other:

2. Are you a current member of the ABA? Yes     No
If you have previously been a member of the ABA, please indicate when you were a member and the reason you discontinued your membership.

3. How long have you been practicing law?

4. Please select one or more areas of expertise:

Administrative Law
Air Emission Permitting & Control
Brownfields
Citizen Suits
Civil & Criminal Enforcement
Clean Water Act Permitting
Energy Distribution and Generation
Environmental Compliance and Auditing
Environmental Counseling
Environmental Insurance Coverage
Environmental Litigation
International Environmental Law
Natural Resource Damages
Site Remediation
Solid & Hazardous Waste
Toxic Tort Cases
Water Resources
Other (please specify):

5. Please describe why you are interested in the Membership Subsidy program and why your selection would satisfy the goals of the program?

6. Do you understand that if you are selected and agree to participate, you are agreeing to join at least one substantive committee, provide your e-mail address to the Section, pay the balance of your dues within 30 days, and participate in Section activities in some meaningful way, such as writing an article for a Section newsletter, Trends, or NR&E, agreeing to serve as a Vice Chair for a Committee, or participating in the planning or delivery of a program?
Yes     No

7. What Section Committee(s) are you interested in joining?

8. What Section program or activity would you plan to become involved?

9. How did you hear about the Membership Subsidy program?

10. Does your organization pay membership dues for the ABA and similar organizations?
Yes     No

11. Have you requested that your organization pay ABA dues? Yes     No

12. Please provide any other information that you would like us to consider in assessing your application.

13. Referencing the attached chart (see Tables A, and B), please indicate how much the ABA's regular dues would be for you.

14. Have you determined that your participation in the Membership Subsidy program would not create a conflict of interest for you that might necessitate your withdrawal from the program? Yes     No

Before you send your application, please review to confirm that you filled out the entire form, double-checking to be sure the information you are submitting is accurate.