Membership Application 

Login User Account Information

1. First name Click to add

2. Last name Click to add

3. Email Click to add

4. Username Click to add

5. Password Click to add

6. Re-type password Click to add

Contact Information

1. Organization Click to add

2. Address1 Click to add

3. Address2 Click to add

4. Address3 Click to add

5. City Click to add

6. Select a State

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   • Choose a State
   • AL
   • Alabama
   • Alaska
   • American Samoa
   • Arizona
   • Arkansas
   • Armed Forces Europe
   • Armed Forces Pacific
   • Armed Forces the Americas
   • CA
   • California
   • CO
   • Colorado
   • Connecticut
   • Dallas
   • DE
   • Delaware
   • District of Columbia
   • Federal States of Micronesia
   • FL
   • Florida
   • GA
   • Georgia
   • Hawaii
   • HI
   • ID
   • Idaho
   • Illinois
   • Indiana
   • Iowa
   • Kansas
   • Kentucky
   • LA
   • Louisiana
   • MA
   • Maine
   • Maryland
   • Massachusetts
   • MD
   • MI
   • Michigan
   • Minnesota
   • Mississippi
   • Missouri
   • Montana
   • NB
   • NE
   • Nebraska
   • Nevada
   • New Hampshire
   • New Jersey
   • New Mexico
   • New York
   • NJ
   • North Carolina
   • North Dakota
   • Northern Mariana Islands
   • NY
   • Ohio
   • Oklahoma
   • OR
   • Oregon
   • PA
   • Palau
   • Pennsylvania
   • Puerto Rico
   • Rhode Island
   • SC
   • South Carolina
   • South Dakota
   • Tennessee
   • Texas
   • TN
   • Utah
   • Vermont
   • Virgin Islands, U.S.
   • Virginia
   • Washington
   • West Virginia
   • Wisconsin
   • Wyoming
 
7. Zip Click to add

8. WorkPhone Click to add

9. HomePhone Click to add

10. Fax Click to add

Extra Information

1. I will see clients after hours
2. I will accept emergency cases
3. I can advise victims concerning their rights in the criminal justice system
4. Please list professional liability insurance carrier and policy limits
   The National Crime Victim Bar Association (NCVBA) requires individuals and agencies to provide copies of current license and expiration date along with relevant professional liability insurance coverage. A certificate of Insurance with NCVBA listed as a certificate holder is acceptable as a copy of current policy declarations. Most insurance companies will automatically send NCVBA annual proof of insurance if we are listed as a certificate holder thus relieving you of having to notify us each year. Please email our Program Associate the appropriate documentation at mvalente@ncvc.org Click to add

5. In what states are you licensed to practice law? Click to add

6. List other states in which you are not admitted but wish to receive referrals Click to add

Experience

1. In What Year Were You First Admitted to The Bar? Click to add

2. How Many Years Have You Been in Private Practice? Click to add

3. What Percentage of Your Practice Involves Civil Litigation? Click to add

4. Approximately what percentage of your current case load involves the representation of crime victims in civil litigation? Click to add

5. How Many Years of Experience Do You Have Working with Crime Victims? Click to add

6. I do not defend persons accused of violent crimes
7. I do not work on behalf of insurance companies
8. Of your civil practice, in what percentage do you represent plaintiffs? Click to add

9. Defendants? Click to add

10. I am knowledgeable about helping victims receive government victim compensation
11. I have represented crime victims in first party or third party civil cases
12. How large is your firm?
    Sole Practitioner
    5 attorneys or less
    6–15 attorneys
    16–25 attorneys
    More than 25 attorneys
13. I am interested in representing victims of: Assault & Battery
    Bullying
    Child Sex Abuse – Adult Survivors
    Child Abuse
    Sex Abuse by Clergy
    Fraud
    Hate Crimes
    Human Trafficking
    Identity Theft
    Police Misconduct
    Sexual Assault
    Sexual Harassment
    Stalking
    Theft
    Wrongful Death
14. I handle the following types of liability claims: Colleges & Universities
    Common Carriers
    Dram Shop Liability
    Employer Liability
    Government Liability
    Hospital Liability
    Insurance Companies
    Mental Health Facilities
    Premises Liability
    Product Liability
    Religious Organizations
    Schools K-12
    Social Host Liability
15. I have experience with the following special issues: Child Victims
    Elderly Victims
    Legal Malpractice
    Restitution
    Victims with Disabilities
16. Please list any languages in which you and/or a member of your staff are proficient: Click to add

17. Please feel free to comment on your legal practice or experience relating to civil justice for crime victims. Include any information that would help us make an appropriate referral to you. Click to add

18. I am currently a member of the American Association for Justice (AAJ)
19. I am currently a member of my State Trial Lawyers Association
20. In fee cases, how are you usually paid? Retainer/hourly
    Contingent fee
    Flat fee
    Hourly rate
    Promissory note as security for fees
    Other
21. I offer payment plans on hourly fees
22. I am willing to consider doing pro bono work with crime victims on a case by case basis

Memberships

1. Please List Any Other Law-Related Memberships that You Maintain: Click to add

Client Billing Practices

1. What Is Your Hourly Rate? Click to add

2. What Is Your Usual Contingent Fee Arrangement? Click to add