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First Name *

Last Name *

Company

Address 1 *

Address 2

City *

State/Province

ZIP *

Phone *

Fax

Email Address *

Website(s)

State(s) licensed to practice law. List all

Years in practice

Years of practice engaged in DUI Defense?

Current % of practice dedicated to DUI Defense?

Are You Currently in Good Standing With Your State's Bar Association?

Have you ever been the subject of a State Bar disciplinary hearing or proceeding?

If yes, please explain with dates and findings. Additional information may be requested.

Member of NCDD since (Year)

Current NCDD Membership Status

Have you previously served in other NCDD leadership positions? (Check all that apply)

Are you currently Involved in any leadership positions in other organizations?

If yes, please explain.

Please list all other legal or defense organizations where you are a member.

Position(s) Interested In. Choose All that Apply

Are you Board Certified by NCDD?

If YES what year you were Board Certified?

Are you interested in becoming Board Certified by NCDD?

If No, please explain

How many NCDD Summer Sessions have you attended?

How many NCDD Winter Sessions have you attended?

How many Mastering Scientific Evidence Seminars have you attended?

How many NCDD/NACDL Las Vegas Seminars have you attended?

Have you attended NCDD's Serious Science for Serious Lawyers Course?

Have you attended NCDD's Metrology seminar?

Have you attended a NCDD SFST Student Course?

Have you attended any of the following courses? Check all that apply.