Membership Application/Renewal Form

Membership Type

New Membership

Renewal

First Name *

Last Name *

Address *

City *

State *

ZIP *

Phone Number *

Email *

**Please use the email you want added to the listserv. PDs must use their personal email.**

Firm or Law School Name *

I HEREBY ATTEST AND CERTIFY THAT I AM A MEMBER OF THE FLORIDA BAR OR A LAW STUDENT IN GOOD STANDING AND THAT I AM NOT ACTIVELY ENGAGED IN THE PROSECUTION OF CRIMINAL CASES.

Signature *

Date *

Membership Category

PRIVATE ATTORNEY $65.00

PUBLIC DEFENDER $40.00

STUDENT (NOT CURRENTLY IN SAO CLINIC) FREE

SPONSOR PUBLIC DEFENDER $40.00

Download Form

Mail form and check to:
PACDL
P.O. Box 17591
Clearwater, FL 33762

Pay via PayPal:
Account info: PACDLDUES@gmail.com
*Email completed form to above email address

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