Name

Address

City State Zip

Phone # e-mail address:

Type of volunteer: Attorney, Paralegal, Process Server , Other - if other please explain:


If other, please list service:



Are you currently authorized to practice law in the state of Tennessee?
Yes or No

BPR #

Types of cases you will take pro bono:



Do you want to be listed on our referral list of private attorneys to receive referrals when clients call who are over our guidelines, may have a fee generating case, etc.? Yes or No

Types of cases to refer