APPLICATION FOR MEMBERSHIP
Print this form, fill it out, and mail it with your check for your dues to:
Justinian Law Society of Ma., Inc.
c/o Capano & DeJoie
101 North Common St.
Lynn, Ma., 01902
(To print, right click here, click on select all, go to file top right, click on print.
 Or simply click on printer icon when available.)

Today’s Date: ____/____/______

Last Name (Print): _____________________________First Name: _____________________Middle Initial: __________

Home Address: ___________________________________City: _____________________State: _____Zip: _________

Home Phone: _____-_____-__________Date of Birth: ___/___/____ Date of Admission to Ma. Bar: ___/___/____

Profession/Employer: ______________________________________________

Business Address: _________________________________City: ________________ State: ________ Zip: __________

College: ____________________________________ Degree: _______________________________Year: _________

Law School: _________________________________ Degree: ______________________________ Year: _________

Affiliations - Legal Specialties: ______________________________________

Email address: ___________________________________________________________________________________

Place X in box next to your choice! Send correspondence to  :Home    Office

Dues remitted:    Regular member -  $60.00         Law Student - $10.00