Communities Speaker Registration Form

First Name

Last Name

Email City

Phone number State Please Select... DC : District of Columbia AL : Alabama AK : Alaska AZ : Arizona AR : Arkansas CA : California CO : Colorado CT : Connecticut DE : Delaware 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 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

D.C. Bar Member Please Select... Yes No

Communities Member Please Select... Yes No

Please check that apply Administrative Law and Agency Practice Arts, Entertainment, Media and Sports Law Criminal Law and Individual Rights Environment, Energy and Natural Resources International Law Family Law Health Law Law Practice Management Public Interest and Courts Taxation

- Antitrust and Consumer Law Corporation, Finance and Securities Law District of Columbia Affairs Estates, Trusts and Probate Law Government Contracts Intellectual Property Law Labor and Employment Law Litigation Real Estate, Housing and Land Use Tort Law

Gender Please Select... Man Woman Nonbinary

Do you identify as transgender Yes No

Size of Organization Please Select... 1-10 11-35 36-75 76-100 101+

Length of Practice Please Select... 0-5 years 6-10 years 11-20 years 21+ years