Waterbury Bar Association - Membership Application

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2011-2012 Membership Application/Renewal

Waterbury Bar Association
P.O. Box 1767
Waterbury, CT 06721

Phone: (203) 753-1938

Please fill out the Membership Application form completely.
Upon hitting submit you will sent to the payment page.

Please click here for a printable
Waterbury Bar Association application/renewal form

Name:

Firm/Employer

Firm/Employer Address:

City:

State:

Zip:

Home Address

City:

State:

Zip:

Telephone #s:

(Work)

(Home)

(Cell)

Email:

*required

Website Address:

Law School and Graduation Year:

Year Admitted to Practice

Primary Practice Areas:

(e.g., criminal, civil, judicial, etc.)

Additional Comments:

COMMITTEES

Please check any/all Committees you are interested
in joining or receiving information from: