Become a Member or Renew Online Please enable JavaScript in your browser to complete this form.Please indicate whether you are joining or renewing an existing membership *JoinRenewPlease select the appropriate membership level *Sustaining Member – $200.00Member admitted more than five years – $95.00Member admitted less than five years – $80.00Law Graduates Awaiting Admission – $80.00Student member – $30.00Name *FirstLastEmail *Phone ContactsBusiness PhoneHome PhoneMobile PhoneAddressesHome addressStreet Address (home) *City (home) *State (home) *Zip (home) *Business AddressLaw Firm / Agency NameStreet Address (business)City (business)State (business)Zip (business)Send Mail toSend mail to *HomeBusinessEducationLaw School *Class of *Expected Graduation Date *Graduation Date *BarsDate of admission to New York Bar *New York Bar department *Other bar admissions and datesSpecialties and ReferralsAreas of concentration (please list your primary areas of practice or expertise)Do you want to be on the referral panel?YesNoDo you charge a consultation fee? *YesNoAreas of specialty for referrals *Are you fluent in another language(s)?YesNoPlease indicate language(s) *QCWBA CommitteesIf you want to serve on a committee(s), please indicate your choices belowMembershipC.L.EProgramsLaw School LiaisonMentoringLegislativePrivate LawInternational Law & Human RightsDomestic ViolenceDiversityGuardianshipVeterans AffairsMember WellnessMagazineWebsiteHow Did You Hear About the QCWBA / Referred By * How hear about us *Additional CommentsAdditional commentsConfirmationBy checking this I assert that I am a member in good standing of the Bar of the State of New York (required) *By checking this I assert that I am a member in good standing of the Bar of the State of New York (required)PaymentDo you wish to automatically renew your dues each year? *YesNoTotal Amount$0.00Credit Card (via Stripe) *CardName on CardSubmit
