L4BL Membership Sign Up

Please Enter Your Contact/Demographic Information
Name*

First NameLast Name
Preferred Pronoun(s)*
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If Other, Please Describe (pronouns):*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
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Please select your race/ethnicity. Please select all that apply.*
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If Other, please describe (race)*
Please select your gender identity. *
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If Other, please describe (gender)*
Social Media Info

Please share your social media info if you would like! We will tag you when relevant.
Twitter Handle
BlueSky Handle
Facebook Profile URL
Instagram Handle
LinkedIn

Please Enter Your Professional Information
Current role in the Ecosystem:*
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Job Title
What is your area of expertise? Select all the apply*
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If Other, Please Describe (expertise):*
Are you licensed to practice law in the U.S.?*

YesNo
Please select the state(s) where you are barred: *
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What school(s) are you affiliated with? *
If you are a clinical professor please include the name of your clinic
Please list the school you currently attend:*
Please select your current year:*
If Other, please explain (school year)*
If any, what organization(s)/affiliation(s)/affinity groups do you work for or associate with?

Membership Information:
I am interested in receiving information on calls to action*

YesNo
I would like to be enrolled in the L4BL Online Community*

YesNo
I would like to participate in one or more of the following Affinity Circles
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I would like to participate in one or more of the following Practice-Based Support Circles
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T-shirt size preference*
How Did You Hear About Us?*
If Other, Please Describe (hear about us)*
Please select your membership dues: *

Membership Dues*

Income less than $40,000 - Lawyer/Legal Worker

$50.00 for each year

Income between $40,000 - $60,000 - Lawyer/Legal Worker

$100.00 for each year

Income between $60,000 - $80,000 - Lawyer/Legal Worker

$150.00 for each year

Income between $80,000 - $100,000 - Lawyer/Legal Worker

$200.00 for each year

Income between $100,000 - $150,000 - Lawyer/Legal Worker

$250.00 for each year

Income greater than $150,000 - Lawyer/Legal Worker

$300.00 for each year

Grad/Law Student

$10.00 for each year

Membership Sign Up Form