Are there any felony charges or disciplinary proceedings pending againts you in PA or elsewhere:
Yes No

Areas of Practice:
Any disaster relief experience: Yes NO

Willing to serve virtually (emails and make calls): Yes No

Willing to go to a site: Yes No

If so, which one? (Bradford, Bucks, Chester, Columbia, Cumberland, Dauphin, Delaware, Lancaster, Lebanon, Luzerne, Lycoming, Montgomery County Public Training Campus, Northumberland, Philadelphia, Schuylkill, Snyder, Sullivan, Susquehanna and Wyoming):

Are you a member of the YLD: Yes No

Are you a member of the Legal Service to the Public Committee: Yes No

If you are not a member, would you like to receive information on becoming a member: Yes No