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PBA Lawyers Saluting Veterans Program

Supreme Court ID No:


Firm Name:

Office Address:


Zip Code:


Are there any felony charges or disciplinary proceedings pending against you in Pennsylvania or elsewhere?


Areas of Pro Bono Service:


Debtor-Creditor Law
Wills and Estate Planning Landlord/Tenant
Immigration Law
Other (please list):

Are you willing to assist in services in your neighboring counties? Yes

Are you accredited by the VBA and admitted to the Court of Veteran Appeals? Yes

Are you a member of the PBA Military and Veterans' Affairs Committee? Yes

If you are not a member, would you like to receive information on becoming a member? Yes

Malpractice insurance is required of all participants.

Insurance Carrier:

Policy #:

Amount of Coverage:

Exp. Date:

I acknowledge that a requirement of my participation in the Pennsylvania Bar Association Lawyers Saluting Veterans program is to have lawyers' professional liability insurance coverage. Therefore, I agree to notify the Pennsylvania Bar Association within 10 days upon the cancellation of my lawyers' professional liability insurance policy.