Membership Application

Please, fill out the entire application form. If you are a Lawyer, select the "Yes, I'm a lawyer" option and complete the questions as requested. Submit your information. You will have an opportunity to verify that the information is correct before your credit card is charged. For questions, call 312-781-2000 or email clla@clla.org. Fields in RED are required.

PERSONAL INFORMATION

Prefix
First name	M.I.	Last name	Suffix
Home address		City	State
Zip Code	Country	Phone	Referred by
Email		Password	Match password
Yes, I'm a lawyer	Preferred Mailing Address:	Office Home	Date of Birth
Bar Number	Jurisdiction(s)	Date admitted to bar	Date Graduated
Yes, I'm ABC Certified
Business Bankruptcy Attorney		Date Certified
Consumer Bankruptcy Attorneys		Date Certified
Creditors' Rights Attorneys		Date Certified

FIRM/COMPANY/SCHOOL INFORMATION

Firm's name		Firm address	Firm address 2
City	State	Zip code	Country
Firm phone	Firm Fax	Website
Yes, this firm is a Certified Commercial Collection Agency

REQUIRED MEMBERSHIPS

OPTIONAL MEMBERSHIPS

PAYMENT INFORMATION

Name on Card	Card Number	Billing Zip	Expiration Date
Card Type Am Ex Visa MasterCard Discover

Membership Application

Prefix

First name

M.I.

Last name

Suffix

Home address

City

State

Zip Code

Country

Phone

Referred by

Email

Password

Match password

Date of Birth

Bar Number

Jurisdiction(s)

Date admitted to bar

Date Graduated

Date Certified

Date Certified

Date Certified

Firm's name

Firm address

Firm address 2

City

State

Zip code

Country

Firm phone

Firm Fax

Website

NATIONAL DUES | REQUIRED

$ 295.00

$ 130.00

$ 50.00

$ 10.00

*I want to join the CLLA as a

SUSTAINING DUES | OPTIONAL

FUND FOR PUBLIC EDUCATION | OPTIONAL

REGIONAL MEMBERSHIPS | OPTIONAL

CLLA PRACTICE SECTIONS | OPTIONAL

INSOL MEMBERSHIP | OPTIONAL

Name on Card

Card Number

Billing Zip

Expiration Date

Card Type