THE VETERANS CONSORTIUM
PRO BONO PROGRAM
Providing Judicial Representation to Veterans at the U.S. Court of Appeals for Veterans Claims

REGISTRATION FORM

COMPLETE, PRINT, AND FAX THIS FORM TO:
 THE VETERANS CONSORTIUM PRO BONO PROGRAM
1600 K Street, NW, Suite 500
WASHINGTON, DC 20006-2833
FAX: 202-328-0063
EMAIL: probonoprogram@nvlsp.org

Name:
Firm:
Address1 (no P.O. Box):
Address2 (no P.O. Box):
City: State: ZIP:
Phone:
FAX:
Email:

Type: Attorney Paralegal Student

Bar Number: State:
Bar Number: State:
Bar Number: State:

Have you ever attended a VCPBP training? YES NO

Please register me for a training on: (check all that apply)

November 18, 2005 (Washington, DC)

April 28, 2006 (Washington, DC)

November 17, 2006 (Washington, DC)

Check all that apply:

I agree to accept referral of one appeal before the U.S. Court of Appeals for Veterans Claims.

Send a training tape. I agree to accept referral of one appeal before the U.S. Court of Appeals for Veterans Claims. I understand that video-trained attorneys will receive cases much later than those who attend a live training.

Please keep me informed of additional trainings.

Please call me to discuss the program.