Join the Lawyer Referral Service

Your First Name:

Your Last Name:

Office Address:

City: State: Zip:

Phone: (work) Phone: (home)

Fax:

Your Email:

Would you like to receive emails notifying you of the name, number and case of a potential client when a referral has been placed? Yes No

B.B.O. Number:

Bar Admission:

Place:

Date:

Years of active legal practice:

In what other states can you practice?

What languages do you speak other than English? (Please indicate level of fluency in field box below)

Please indicate your level of fluency:
 Beginner Intermediate Conversational Fluent
Please use this field for any additional languages (please note fluency levels for each additional language):

Has any disciplinary action ever been instituted against you by the Board of Bar Overseers of Massachusetts or any other equivalent body in another jurisdiction?
 Yes No

- If yes, please describe the nature of the outcome of such disciplinary action

MALPRACTICE

The LRS requires each panel member to carry legal malpractice insurance coverage of at least $250,000/$500,000. LRS members must submit proof of insurance every year along with their membership renewal forms.
Have you emailed us a copy of the current declaration page from your legal malpractices insurance policy?  Yes No

AREAS OF LAW

Please indicate all applicable areas of your practice:
Appellate:  State Federal
Criminal:  Misdemeanor Felony Federal Juvenile License Suspension
Discrimination:  Public Accommodation Housing Disability Education Employment
Employment Law:  Wrongful Termination Contracts Labor Law (Unions)
Benefits:  Unemployment Workers’ comp SSI/SSDI Disability
Family Law:  Divorce Custody Guardianship DCF
Malpractice:  Medical Dental Legal
Rights:  Civil Rights People of Color Women Gay/Lesbian Transgender Prisoners’ Rights Patients’ Rights FOIA/Privacy Act Police Misconduct Civil Disobedience
Landlord/Tenant:  Landlord Tenant
Miscellaneous Areas:  Civil Litigation Immigration Elder Law ADR or Mediation Auto Accidents Personal Injury Products Liability Consumer Protection Bankruptcy Debtor or Collections Taxes Contracts Real Estate Estates Wills Patents or Copyrights Business or Commercial Organization Student Issues Environmental Law

Other Areas of Special Interest:

GEOGRAPHICAL LOCATION

Are you willing to travel to clients?
 Yes No

What areas/cities would you like to receive referrals from? Check all that apply.
 Boston Metropolitan North Shore South Shore Cape Cod Central Mass Western Mass
Other areas/cities:

ATTORNEY’S FEES

Indicate your average fees for the following:

Consultations:
Uncontested no-fault divorces:
District Court criminal trials:
Hourly:
Other (list type and range):

Do you offer sliding scale or reduced rates for low
or moderate income people? Please describe.

Do you take pro bono cases? What types?

GUILD MEMBERSHIP

Are you a Guild member in good standing? Yes No

When did you join the Guild?

How did you learn about the LRS?

Why would you like to join the LRS?

APPLICANT STATEMENT

By clicking submit on this application form you certify that your responses are complete and true to the best of your knowledge. If accepted as a member of the LRS, you agree to abide by LRS rules as indicated at the top of this online application. You understand the objectives of the LRS, and you agree to work toward providing high quality, low cost services to low income people.

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