Microsoft Word - 2021 LRIS New Member Application (FINAL).docx

ORANGECOUNTYBARASSOCIATION

LAWYERREFERRAL&INFORMATIO



NSERVICE(LRIS)APPLICATION

2024NEWMEMBER

LastName FirstName MI StateBarNo. YearAdmittedtoStateBar

FirmName BusinessPhone Fax

StreetAddress Suite# City/State/Zip

________________________________________________________ ________________________________________________________

Websiteaddress(ifavailable) EmailAddress

(Byprovidingyouremailaddress,youagreetoallowtheLRISto

________________________________________________________ emailyouregardingrelevantLRISinformation.)

Howdidyouhearaboutus?

IamamemberoftheOrangeCountyBarAssociation,andhaveenclosedmycheckinthesumof$225.00forannual

LRISmembershipdues.(Pleasenotethatduesarebasedonthecalendaryearandarenotpro‐rated.)

IamnotamemberoftheOrangeCountyBarAssociation,andhaveenclosedmycheckinthesumof$450.00

forannualLRISmembershipdues.(ToobtainOCBAmembershipinformation,pleasecontacttheMembership

Departmentat949/440‐6700.)

IamamemberoftheOCBAandinterestedinrenewing/joiningtheModestMeanspanelonly,andhaveenclosedmycheckin

thesumof$75.00.LRISmembershipfeeiswaivedfortheImmigrationLawpanel.

TOTALFEESENCLOSED $

MEMBERSHIPDUESARENON‐REFUNDABLE

Pleasecheckthatyouhavereadthefollowing:

IhavereadLRISRule8.3andagreetopaytotheLawyerReferral&InformationServiceaforwardingfeeof15%ofanyandallfees

collected(exceptforModestMeansreferrals)fromallclientsreferredtomebytheLawyerReferral&InformationService.

ImaintainanofficeinOrangeCounty,CaliforniaasdescribedinLRISRule5.1.

Pleasecheckallthatapply:

IhaveattachedproofofmycurrentErrorsandOmissionsinsurancepolicy(CertificateofInsuranceorDeclarationsPageonly).

IamwillingtotraveltootherCourtJurisdictions: LosAngeles Riverside SanBernardino SanDiego

Iaminterestedinreceivingbilingualreferrals. Staffisbilingual Attorneyisbilingual Both

Language(s):

IamlicensedtopracticeinanotherState.Bar#______________________ State:_______________________________________



Ihaveread,understandandagreetobeboundbyalltheRulesoftheOrangeCountyBarAssociationLawyerReferral&Information

Serviceasofthedatehereof,orasamendedhereafterasprovidedforbysuchRules.IhavereadandagreetobeboundbytheRules

ofProfessionalConductgoverningattorneysintheStateofCalifornia.Iwillberesponsibleforcompliancewithallrules,regulations

andrequirementswhichareimplementedsubsequenttothedateofthisapplicationbytheLawyerReferral&InformationService

Committee,LawyerReferral&InformationServiceAdministrator,ortheOrangeCountyBarAssociation.

______________________________________________ ___________________________

(Signature) (Date)

THISFORMISREQUIREDANDMUSTBESUBMITTEDATTIMEOFAPPLICATION.



DECLARATIONRE:DISCIPLINARYSTATUS



ThisdeclarationissubmittedtoenabletheLawyerReferral&InformationServiceoftheOrangeCountyBarAssociation

tocomplywiththeprovisionsoftheCaliforniaCivilCodeSection43.95.



DECLARANTINFORMATION:

NAME:  

FIRMNAME: 

ADDRESS: 

(StreetAddress,SuiteNo.)



(City,StateandZipCode)

TELEPHONE: ()

YEAROFADMISSIONTOTHESTATEBAR: 



Declaration:

1. Haveyou ever been refusedadmissiontopractice,disbarred, suspendedfrom practice or formally

reprimandedbyanystatelicensingoradministrativeagency,areanysuchproceedingsinprogress,or

have you been notified that filing of any such proceeding may be imminent?  If yes, explainon a

separatesheet.



Yes

No 

2. Haveyouhadanyjudgmentsenteredagainstyou,orhaveyouenteredintoanysettlementsinvolving

any monetary payments by you to the claimant, relating to any claims or actions filedagainst you

alleginganyliabilityarisingfromtheperformanceofprofessionallegalservices?Ifyes,explainona

separatesheet.



Yes

No 

3. Have you ever been declined, canceled or refused renewal for any policy of professional liability

insuranceforreasonsotherthannon‐paymentorpoorcredit?Ifyes,explainonaseparatesheet.



Yes

No 

4. Haveyoueverbeenconvictedofacriminaloffense?Ifyes,explainonaseparatesheet.



Yes

No 

5. Haveyoubeendeclined,refusedrenewalorexpelledfromanyotherreferralservice,orisanysuch

actionpending?Ifyes,explainonaseparatesheet.



Yes

No 

6. HasanyCourtimposedsanctionsagainstyou(otherthandiscovery related sanctions) in excess of

$1,000?

Yes No 

 



Bysigningbelow,Iagreetohold LRIS harmless from material misrepresentations or omissions concerning the above and

understandthatthesameorfailuretoprovideLRISwithtrueandcompleteinformationmayresultinmyimmediateexclusion

fromtheLRISpanels.IalsoagreetoinformtheLRISunderpenaltyofperjury,thattheforegoinginformation,includingany

supplementaryinformationistrueandcorrecttothebestofmyknowledge.



   

(SignatureofDeclarant)(Date)

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ORANGE COUNTY BAR ASSOCIATION

LAWYER REFERRAL & INFORMATION SERVICE PANEL BREAKDOWN

Please select from the following list of main panels (limit 6) and sub-categories (no limit) the Lawyer

Referral & Information Service uses to make referrals. The $25.00 administrative fee is not charged to a

client for Panels indicated with “(NO FEE FOR CLIENT)”.

Modest Means Program: (See attached Modest Means Program Guidelines)

The panel members on this program agree to provide reduced fee services to callers who meet the eligibility

requirements. The 15% forwarding fee is waived for all Modest Means referrals. Referrals under this

program will be in addition to all other referrals and will not in any way affect your rotation on any other

panel.

(MUST RETURN ALL PAGES OF PANEL BREAKDOWN)

ADMINISTRATIVE

DMV hearings/license suspension Liquor l icense/Alcohol Beverage Control

Education of the handicapped/Special Ed IEP Problems with schools – students re: Discipline

Federal agencies Professional discipline/license

Federal Trade Commission Restaurant & other business licenses

Government - complaints against the “system” Student Loans / Wage Garnishment

Gun permits Unemployment benefits

Interstate Commerce Commission Utilities

ADMIRALTY

Injuries

Jones Act

Marina problems/contracts

ADOPTIONS

Adult Adoptions Marital adoptions

Defending rights of birth parents Private adoptions

Kinship, foster care Step Parent Adoptions

Termination of Parental Rights

BANKRUPTCY

I would like to receive Modest Means referrals for this panel.

Asset Protection Chapter 7, Personal Bankruptcy

Adversary Proceeding Chapter 13, Business Bankruptcy

Business Chapter 11/Plan of Reorganization Chapter 13, Personal Bankruptcy

Business bankruptcy (other) Receivership

Creditors’ Rights Straight bankruptcy involving professional practice

BUSINESS LITIGATION

Intellectual Property Litigation (for the Intellectual Property transactional panel, see Intellectual Property panel)

Anti-trust Trade secrets

Fraud Unfair competition

CIVIL APPELLATE (not considered as a main panel)

Corresponding panel (s) _____________________________________________________________________________

CONDEMNATION

Eminent Domain

YOU MAY JOIN A MAXIMUM OF 6 MAIN PANELS

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CONSUMER

I would like to receive Modest Means referrals for this panel.

Auto repair contracts Contests / Gaming

Car Dealers/Auto contracts Home improvement & repair

Clean up credit Identity theft

Collections – Creditor / Plaintiff Internet purchases / fraud

Collections – Debtor / Defendant Judgment – Creditor

Collections – Personal non creditor related Lemon Law

Consumer Fraud Small Claims Court

Contracts for purchase of goods and services Warranties

Credit & bank problems Repossessions

CORPORATE & BUSINESS

Business dissolutions International

Business disputes (e.g. breach of contract) Litigation

Business formations Mechanics liens

Buying & selling businesses Non-profit organizations

Contracts Partnerships

Collections Securities & Commodities

Franchises Structured Settlements

Incorporation LLC Formation

Transactional

CRIMINAL (NO FEE FOR CLIENT)

I would like to receive After Hours referrals for this panel.

Misdemeanors

Battery

Domestic Violence

DUI

Grand Theft (under $950)

Violation of Restraining Order

Sex Crimes

Victim/Witness

Other Misdemeanors

Low Grade Felonies

Commercial Burglary

Drug—Intent to Sell

Drug—Possession

Firearms—Possession

Grand Theft (over $950)

Assault

DUI with Injury

Child Abuse/Neglect/Endangerment

Victim/Witness

Other Low Grade Felonies

Military

Post-Conviction

Criminal Appeals

Habeas Corpus

Parole/Probation Violations

Expungements

Serious/Violent Felonies (Strikable Charges)

Kidnapping

Arson

Drug-Intent to sell, firearms present

Residential Burglary

Aggravated Assault

Homicide

Carjacking

Robbery

Sex Crimes

Child Molestation

Child Abuse

Gang Crimes

Victim/Witness

Federal Crimes

RICO

Conspiracy

Drug Offenses

Federal White Collar (mail fraud, wire fraud,

securities fraud)

Weapons

Internet Crimes

Victim/Witness

White Collar/Fraud

Embezzlement

Fraud (insurance, welfare, real estate, bank, etc.)

Victim/Witness

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DISCRIMINATION & CIVIL RIGHTS

Age discrimination Police misconduct/discrimination

AIDS discrimination Racial

Americans with Disabilities Act Sexual harassment

Discrimination in housing Police brutality

False arrest/imprisonment Violation of constitutional rights

ELDER LAW

I would like to receive Modest Means referrals for this panel.

I am interested in receiving Adult Protective Services (APS) referrals for this panel. (NO FEE)

I am interested in receiving Ombudsman referrals for this panel. (NO FEE)

I would be willing to make home/facility visits.

ENTERTAINMENT

Art Publishing

Film Sports Contracts

Modeling Television

Music/Recording Theater

ENVIRONMENTAL

Land use Pollution

Mining & Mineral Toxic Wastes

Mold Natural Resources

Oil & Gas

FAMILY (NO FEE FOR CLIENT)

I would like to receive Modest Means referrals for this panel.

I would like to receive Limited Scope referrals for this panel.

I would like to receive After Hours referrals for this panel.

Annulments Name change

Collaborative Law Non Income Spouse

Divorce Prenuptial agreements

Domestic Partnerships Post-Divorce

Interstate Qualified Domestic Relations Orders (QDRO’s)

International Restraining order

Legal separations Spousal abuse

Mediation Spousal support

Military Divorce

Child Custody Issues…

Child support collection Grandparents rights

Child support modification Guardianship

Child support Defense Paternity

Contested custody Visitation

Divorce with children involved Domestic disputes involving children

Public Benefits (Age 65 and over)

Appealing denials of eligibility for public benefits and

entitlements

Fiduciary Abuse

Medical liens and estate claims

Medicare advocacy and appeals

Rights of long term care residents

SSI

Nursing Home Abuse and Other Elder Abuse Litigation

Actions Against Skilled Nursing Facilities

Consumer Fraud

Elder Abuse Litigation under EADACPA

Protection from Physical Abuse: Injunctive Actions

Planning for Incapacity

Durable powers of attorney for long term care (health

and financial)

Estate Planning (long term care)

Long-term care insurance

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HOUSING

I would like to receive Modest Means referrals for this panel.

Commercial Tenant

Evictions Public housing – Section 8/HUD

Landlord Residential

Lease / Rental Agreements

Mobile home – Property Rental

IMMIGRATION & NATURALIZATION (NO FEE FOR CLIENT)

I would like to receive Modest Means referrals for this panel.

Adjustment of Status Naturalization

Administrative Appeals Nonimmigrant Visas

Asylum/Withholding/CAT Post-Conviction Relief

Bond Hearings Removal Defense

Consultation for Detainees Special Immigrant Juvenile Status

Deferred Action T Nonimmigrant Visas

Employment Authorization U Nonimmigrant Visas

Employment Based Immigrant Petitions VAWA

Family Petitions

INSURANCE

Accident HIPAA

Annuities Life/Waiver of Premiums/Death Benefits

Arbitration between insurance companies Medical Payments

Bad Faith Obligation of Defense & Indemnity

COBRA Private Policy

Disability Insurance Punitive Damage Issues

Health / HMO Settlements

Homeowner’s / Fire/Property / Casualty

INTELLECTUAL PROPERTY (For Intellectual Property Litigation, see Business Litigation panel)

To receive referrals for Patents please include your Patent & Trademark Office Registration No.

Anti-trust Starting or establishing Patent

Computer software licensing Starting or establishing Trademarks

Copyrights Trade secrets

Internet Law Unfair competition

INTERNATIONAL

Chemicals International trade agreements

Currency violations Licensed to practice/affiliated office in other counties

Customs & tariffs Reparations

Electric Smuggling

Failure to declare

JUVENILE

Abuse or neglect by parents Dependency / Emancipation of a minor

Criminal matters involving juveniles Termination of parental rights

Delinquency

LABOR Labor Board Appeals

COBRA Pension / Profit Sharing

Civil service / Government employees Severance Package

Disciplinary action by employer Severance Package - Executive

Discrimination on the job Union Disputes

Employee contract/breach of contract Union – Education Professionals

Employee representation Wage and Hour Claims

Employer representation Wage garnishment

ERISA Whistleblower

Family and Medical Leave Act Wrongful/abusive termination

Federal Employees Workers’ Compensation Retaliation

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LEGAL MALPRACTICE

Defense Plaintiff

Fee Arbitration for Client / Attorney Disputes State Bar Discipline Hearings

MEDICAL MALPRACTICE (NO FEE FOR CLIENT)

Arbitration

Breast Implant Litigation Medications

Cosmetic / Plastic Surgery Misdiagnosis / Improper Treatment

Chiropractic Paralysis

Defense Psychiatric

Dental malpractice Surgery

Laser Eye Surgery Wrongful Death

Mental Health Facility

MENTAL HEALTH

Caregivers Assistance In-competency

Familiar with assistance for Alzheimer Mental Health Facility - Releases

Discrimination based on mental health

MILITARY

Active Status Medical Malpractice (against VA)

Court Martial Veterans

Criminal Matters Administrative Separations

Reservists

PERSONAL INJURY & PROPERTY DAMAGE (NO FEE FOR CLIENT)

I would like to receive After Hours referrals for this panel.

Asbestos / Chemicals Mass disasters

Abuse of process/Government entities Mold

Animal bites & attacks Non Domestic Restraining Order

Assault and Battery Premises liability

Auto Accidents Product liability

Aviation Accidents Slander

Class Action Slip and Fall

Defamation Structured Settlements

Defense Tavern owner’s liability

Injured animals Torts/Negligence

Invasion of privacy Veterinary malpractice

Libel Wrongful Death

Malicious prosecution Paralysis

Medications

REAL PROPERTY

Agricultural/livestock Neighbor disputes

Broker/Agent/Escrow company problems Preparation of deeds

Commercial Property purchases, sales, leases

Condominiums Property line dispute with neighbor

Construction issues Public Housing / HUD

Co-op conversions Rescission

Easements Residential

Financing / Mortgages / ARM Loan / Reverse Short Sale

Foreclosure Subdivisions

Homeowner’s association Time Shares

Homesteading Transfer of business

Land Transfer of Interest / Quit Claim

Loan Modifications Variances

Mechanical Lien Water Issues

Mobile homes Zoning and permits

Mortgage Fraud

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SOCIAL SECURITY (NO FEE FOR CLIENT)

Appeals Social Security Disability

Foreign social security/pensions SSI

Medical-Cal / Medicaid State disability

Medicare Welfare

Overpayment

TAXATION

Audits - IRS Individual planning

Business & large personal Interstate/international

Corporate planning Offer & Compromise

ERISA Tax litigation

Federal, State & local personal Trust & estate income taxes

WILLS, TRUSTS & ESTATES

Assistance for caregiver’s Estate & trust planning

Complex litigation Guardianship

Conservatorship Probate & Estate Administration

Death of a tenant Special needs trust

Death transfers Will drafting & review

Durable power of attorney Will contests

WORKERS’ COMPENSATION (NO FEE FOR CLIENT)

All injuries suffered during course of employment

Appeals

Chemicals

Defense

Federal

Harassment (stress related)

Insurance settlements

State

Name (Please print) Date Phone

Please return to: ORANGE COUNTY BAR ASSOCIATION

Lawyer Referral & Information Service

P.O. Box 6130

Newport Beach, CA 92658

Or upload to: www.ocbar.org/LRISportal

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Revised July 2019

TYPES OF MATTERS REFERRED UNDER MODEST MEANS (MM)

15% forwarding fee and $25 administrative fee is waived for all Modest Means referrals

MM BANKRUPTCY (NO FEE FOR CLIENT)

Adversary Proceeding Chapter 13, Personal Bankruptcy

Business Chapter 11/Plan of Reorganization Chapter 13, Business Bankruptcy

Creditor’s rights Receivership

Chapter 7, Personal Bankruptcy Straight bankruptcy involving professional practice

MM CONSUMER (NO FEE FOR CLIENT)

Auto repair contracts Home improvement & repair

Car Dealers/Auto contracts Identity theft

Clean up credit Internet purchases / fraud

Collections Lemon Law

Consumer Fraud Repossessions

Contracts for purchase of goods and services Small Claims Court

Credit & bank problems Warranties

Contests / Gaming Judgment-Creditor

*MM ELDER LAW (NO FEE FOR CLIENT)

MM FAMILY (NO FEE FOR CLIENT)

Annulments Mediation Post Divorce

Divorce Military Divorce QDRO’s

Domestic Partnerships Name change Restraining order

Interstate Non Income Spouse Spousal abuse

International Prenuptial agreements Spousal support

Legal separations

Child Custody Issues

Child support collection Divorce with children Grandparents rights

Child support modification involved Guardianship

Child support Defense Domestic disputes Paternity

Contested custody involving children Visitation

MM HOUSING (NO FEE FOR CLIENT)

Commercial Landlord Lease/rental agreements

Evictions Tenant Public housing

Residential Mobile Homes

MM IMMIGRATION & NATURALIZATION (NO FEE FOR CLIENT)

Adjustment of Status Employment Authorization Removal Defense

Administrative Appeals Employment Based Immigrant Petitions Special Immigrant Juvenile Status

Asylum/Withholding/CAT Family Petitions T Nonimmigrant Visas

Bond Hearings Naturalization U Nonimmigrant Visas

Consultation for Detainees Nonimmigrant Visas VAWA

Deferred Action Post-Conviction Relief

Public Benefits (Age 65 and over)

Appealing denials of eligibility for public

benefits and entitlements

Fiduciary Abuse

Medical liens and estate claims

Medicare advocacy and appeals

Rights of long term care residents

SSI

Nursing Home Abuse and Other Elder Abuse Litigation

Actions Against Skilled Nursing Facilities

Consumer Fraud

Protection from Physical Abuse: Injunctive Actions

Planning for Incapacity

Durable powers of attorney for long term care

(health and financial)

Estate Planning (long term care)

Long-term care insurance

Special Needs Trust-personal injury &

disabled