Fill and Sign the Application for Admission to the Bar of the Court Form

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO APPLICATION FOR ADMISSION TO THE BAR OF THE COURT Pursuant to D.C.COLO.LR 83.5, admission to the bar of this court is limited to persons of good moral character li- censed by the highest court of a state, federal territory or the District of Columbia where a written examination was required for admission, and who are in good standing in all courts and jurisdictions where admitted. FULL NAME: (M OTHER NAMES USED: BUSINESS ADDRESS (INCLUDE FIRM NAME): CITY: STATEZIP: OFFICE TELEPHONE: ( ) OFFICE FAX: ( ) SOCIAL SECURITY NUMBER: DATE AND PLACE OF BIRTH: RESIDENCE TELEPHONE: 1. I received my license(s) to practice law in (State, Federal Territory or District of Colum-on , . (Date) 2. I am admitted to practice in the following courts: (attach a separate sheet if necessary) Court Address Admission Date/Reg. No. 3. I certify I am a member in good standing in all courts to which I have been admitted. 4. Have you ever been disbarred, suspended or censured, or received a reprimand pertaining to your conduct or fitness to practice law or membership in the bar of any court or other attorney licensing agency? Yes ______ No ______ If the answer is “yes”, attach a separate sheet or sheets giving a full explanation, including date, address and telephone number of the court or licensing agency, discipline imposed, and date and conditions of reinstatement (if any). 5. I consent to this court’s exercise of disciplinary jurisdiction over me in connection with this application and any alleged misconduct related to my admission to and practice before the bar of this court. (Over) ) (F ) ( ) My attorney registration number is (If admitted in more than one jurisdiction by examination, attach a separate sheet giving additional information) 6. I certify that I have read and am familiar with the local rules of this court and that I will comply with all of the provisions thereof. 7. I recognize that, if admitted to the bar of this court, I am duty bound to give immediate written notice to the Clerk of this court of any formal discipline imposed upon me, including dates and terms thereof, by any court or attorney licensing agency. 8. I solemnly swear (or affirm) that as an attorney and counselor of this Court, I will conduct myself in a professional and ethical manner at all times, and that I will support and defend the Constitution of the United States. Signature Subscribed and sworn to before me this Day of , . My Commission Expires: Notary Public or Clerk of Court THIS APPLICATION SHOULD BE ACCOMPANIED BY A CHECK IN THE AMOUNT OF $60.00 MADE PAYABLE TO “THE CLERK, UNITED STATES DISTRICT COURT” James R. Manspeaker, Clerk United States District Court U.S. Courthouse, Room C-145 1929 Stout Street Denver, Colorado 80294-3589 (303) 844-3433 Rev. (4/99)