Georgia Defense Lawyers Association
Membership Application

Name: ________________________________ State Bar No.: ____________________

Firm Name:____________________________________________________________________

Street Address: _________________________________________________________________

City, State, Zip: _________________________________________________________________

Tel: ______ - _______ - _________ Fax: ______ - _______ - ________

E-Mail: ____________________________________________________________

Web site: ___________________________________________________________

Date Admitted to Bar: ___________________ Date Began Practice: ____________________

Number of years with present affiliation: _________________________

Number of individuals in your firm presently members of GDLA: _______

Who (if anyone) referred you to the GDLA? ______________________________________________

Personal Information*

Birthdate: __________________________ Spouse's First Name: ______________________

Home Address: _____________________________________________________________________

Tel: _______ - _______ - _________

*Personal information is not displayed in the online membership directory and is used only to help facilitate office activities such as spousal attendance at meetings, condolences, etc.

To Apply for Active Membership

I certify that I am a lawyer in private practice and I am substantially engaged in litigation, primarily for the defense, in the State of Georgia and I am a member in good standing of the State Bar of Georgia.

__________________/___________________________ (Date) (Signature of Applicant)

To Apply for Associate Membership

I certify that I am a lawyer and I am employed by and actively engaged on a full time basis in the claims work of a company doing business in the State of Georgia.

__________________/___________________________ (Date) (Signature of Applicant)

Upon completion of this form, please mail it to the Chairman of the Membership Committee, Morton G. Forbes, Post Office Box 13929, Savannah, Georgia 31416-0929, along with a check for $270.00 (which includes the application fee of $100.00 and one year dues). (If you have been admitted to the Bar 5 years or less, enclose a check for $185.00, which includes the application fee of $100.00 and one year dues). Applications and dues received after Fall Board meeting will be prorated and all overages shall be credited to the next year's dues. For further information, call 912-352-1190. Upon approval for membership, you will be notified.