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PLAN Application - Attorney
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* Indicates required question
Please enter your first and last name:
*
Your answer
Please enter a phone number and/or email address where you can be contacted:
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Your answer
Are you an attorney with an active license to practice law in at least one state?
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Yes
No
Please list the states where you are licensed to practice law:
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Your answer
Have you ever been subject to discipline for any actions related to your practice of law?
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Yes
No
(Optional) Please specify the areas of law that you have experience with:
Disability Law
Health Law
Employment Law
Contract Law
Other:
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