LSBA Elections - Qualifying Form

Qualify Member Indicated for the Below Position(s)

Louisiana State Bar Association Board of Governors*
Sixth, Seventh and Eighth Board Districts ONLY

Louisiana State Bar Association Nominating Committee*
Nominating Committee Districts 1A, 1B, 2A, 2B, 2C, 3A, 3B, 3C, 3D and 3E

Louisiana State Bar Association House of Delegates*
First through Nineteenth Judicial Districts

American Bar Association House of Delegates
Two (2) Delegates from Membership at Large and one (1) Young Lawyer Delegate
Candidates must be members of the American Bar Association

Candidate's Information

First Name:

Middle Initial:

Last Name:

Office Address 1:

Office Address 2:

City:

State:

Zip:

Phone:
format: 000-000-0000

Fax:
format: 000-000-000

E-mail:

Board District:

Judicial District:

Nominating Committee Parish:

ABA Member Number:

Date of Birth:

Month: Day: Year:

By selecting this checkbox, you certify by completing this form that the permission of the member nominated has been obtained.

* No member of this association shall be a candidate for or hold more than one office in this Association at any one time. The term "office" shall include President, President-Elect, Secretary, Treasurer, member of the Board of Governors of this Association, and member of the House of Delegates of this Association. The term "office" shall not include members of the House of Delegates of the American Bar Association, or an office in a section of this Association. The House of Delegates Liaison to the Board of Governors shall not be subject to this prohibition.

Candidate's Biographical Data (optional)

Candidate's Nickname:

Law School:

Year Admitted in Louisiana:

Advanced Law Degree:

Yes No

Advanced Law Area:

Other Professional Licenses:

Louisiana State Bar Activities (list top five and dates)

Local/Specialty Bar Activities (list top five and dates)

Law School Activities (list top five and dates)

Verification Code:

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Bar Governance

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