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Attorney Application - WFCD
New members to the collaborative divorce teams - please fill out this form.
* Indicates required question
Name
*
Your answer
Business Address
Your answer
Email
*
Your answer
Work phone number
Your answer
Cell phone number
Your answer
Website Address
Your answer
FL Bar Number
Your answer
Jurisdictions admitted to practice
Your answer
Dates admitted to bar
Your answer
Years of practice
Your answer
Approximate percentage in Family Law
Your answer
Are you certified as a family mediator
Yes
No
Clear selection
Original year of certification
Your answer
Check which Collaborative Divorce Training/Certification you have completed
Introductory Training
Advanced Training
Certification Training
Reason for joining the collaborative divorce group
Your answer
Disciplinary Actions: Has your license to practice in any jurisdiction ever been denied, restricted, suspended, revoked, or had any other disciplinary action taken against you? If yes, please explain what occurred and the outcome.
Your answer
Three References: Name, Email, and Daytime Telephone #(Two of whom are members of West Florida Collaborative Divorce and one of whom is practicing in your field)
Your answer
Three References: Name, Email, and Daytime Telephone #(Two of whom are members of West Florida Collaborative Divorce and one of whom is practicing in your field)
Your answer
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