LRS Membership Application

Lawyer Referral Service of Santa Cruz County
Sponsored by Santa Cruz County Bar Association

P.O. Box 1311 • Santa Cruz, CA 95061
Tel: (831) 425-4755 • Fax: (831) 423-6202 • Email: sccbar@sbcglobal.net


APPLICATION FOR MEMBERSHIP


July 1, to June 30,


Membership shall be for the fiscal year. Acceptance for current fiscal year does not
guarantee acceptance for any following years. Each member shall apply annually.

I hereby apply for membership in the Lawyer Referral Service ("LRS"), sponsored by the Santa Cruz County Bar Association and certified by the State Bar of California (#0055) and make the following representations:

1. Contact Information

NAME:    FIRM NAME:    
PHONE:        FAX:        CELL:  
OFFICE ADDRESS:    
MAIL ADDRESS:    EMAIL:  
WEB SITE ADDRESS:  
YEAR ADMITTED TO CALIFORNIA BAR    STATE BAR #  

2. Section A - Panels

I wish to be a member of the following LRS Panels. I have read the local Rules of the LRS, and I meet or exceed the minumum criteria for membership in each of the Subject Matter Panels to which I am applying, and have signed the Self-Certification of Subject Matter Panels at the end of this form.

SUBJECT MATTER PANELS

Appellate (no panel fee)
Criminal
Civil
Bankruptcy (one panel fee)
Chapter 7 Chapter 13
Chapter 11                Other
Business (one panel fee)
Entities: Formation/Operation
Non-Profit Corporations: Formation & Operation
Contracts - Drafting & Review
Securities
Civil Litigation (one panel fee)
Collection (no panel fee)
Consumer (no panel fee)
Auto Contracts/Lemon Law
Product Liability
Other
Criminal Defense (one panel fee)
Misdemeanor
Felony
     Major Felony
     Juvenile Delinquency
Elder and Youth Law (one panel fee)
Elder Law
     Special Needs Trusts
     Public Benefits
Adoption
     International Adoptions
     Native American Adoption
CPS/Dependency
Emanicpation
Employment: (no panel fee)
Labor/Union     Wages/Benefits
Harassment     Wrongful Termination
Discrimination:    
     Age Sex Race Other
Estate Admin/Probate (one panel fee)
Litigation Conservatorship
Guardianship Estate Administration
Elder Abuse
Estate Planning (one panel fee)
Wills & Trusts Powers of Attorney
Trust Administration
Family Law (one panel fee)
Dissolution with and w/out minor children    
Prenups    
QDROs    

Government Benefits (no panel fee)
Immigration/Naturalization (no panel fee)
Insurance Coverage (one panel fee)
Landlord/Tenant (one panel fee)
Discrimination/ADA
Mobile Home
Other
Malpractice (no panel fee)
Legal Malpractice
Medical Malpractice
Patent/Trademark/Copyright
Personal Injury/Torts (one panel fee)
Real Property (one panel fee)
Sales/Exchanges
Titles
Construction
Financing
Loan Modifications
Foreclosure
Mobile Homes
Neighbor Disputes/Easements
Mechanic's Liens
Timeshares
Zoning and permit use application process,
      including administrative hearings
Other
Small Claims (no panel fee)
Taxation (one panel fee)
Traffic (one panel fee)
Workers' Compensation (no panel fee)
GENERAL PANEL: (If not listed above, specify)

I have signed the Self-Certification of Experience, included hereto as Page 5 of this Application for Membership, as proof of my qualifications for the Subject Matter Panels and/or Arbitration/Mediation.

- or -

I am a State Bar Certified Specialist in

B. APPLICATION DECLARATIONS

  1. Consultation Fees: I understand that the only fee charged to the client for the first half hour consultation shall be $50.00. I agree to promptly collect and forward the $50.00 consultation fee to the LRS office, P.O. Box 1311, Santa Cruz, CA 95061, within SEVEN (7) DAYS FROM APPOINTMENT DATE. If I fail to collect the $50.00 referral fee at the time of appointment, it is my responsibility to subsequently collect that fee and forward it to the LRS office. I understand that it is not the responsibility of the LRS office to collect that fee. I understand that I may not waive a fee for an initial consultation for any reason unless previously arranged with the LRS office. I further agree to return the fully filled out blue referral form within seven (7) days from the date of the appointment. If the blue referral form and/or the consultation fee are not returned within the time frames outlined above, LRS may provide verbal notice (through a phone call to my office) and written notice (letter, fax, Email) describing a date certain within which those items are to be returned. I understand and agree that Lawyer Referral Service has the authority to remove my name from consideration for further referrals if the consultation fees and the blue referral forms are not returned to the LRS office by the final due date.

  2. Contracts With Clients: I am free to contract with the client for additional legal services at my regular rates. I agree to promptly forward 15% Net of all such additional fees to the LRS, within 30 days of collecting and earning said fees. My written fee agreement with the client will reflect this arrangement in a form substantially as follows:
    "[Client]________________________ was referred to Attorney by the Lawyer Referral Service of Santa Cruz County. Fifteen percent (15%) of any attorney fees will be forwarded to LRS in accordance with LRS rules. This feesharing arrangement shall not increase Client's costs for legal services beyond that which the Client would normally pay."

    LRS will provide me with verbal (through a telephone call to my office) and written (letter, fax, Email) notice of the fact that the above described fees have not been submitted and will provide a date certain as to when those fees should be submitted to LRS. I further understand and agree that LRS has the authority and right to remove my name from consideration for further referrals until I have submitted fifteen percent (15% Net) of any additional fees to LRS, as outlined above, by that date. I will return a 15% Net form for each client with any 15% Net fees that are forwarded to the LRS Office and will completely fill out form with the information requested.

  3. Insurance: I certify that I am covered under a policy of errors and omissions insurance in a minimum amount of $100,000/$300,000 and I AM ATTACHING A COPY OF THE FACE SHEET OF SAID POLICY. IF MY INSURANCE SHOULD LAPSE OR BE CANCELED DURING THE TIME I AM A MEMBER OF THE LRS, I SHALL IMMEDIATELY NOTIFY THE LRS. I understand and agree that having insurance in the above-described amounts is a prerequisite to receiving any LRS referrals. By accepting an LRS referral, I am warranting that I continue to maintain an insurance policy in conformity with LRS rules, and that such policy is in good standing. I further recognize and agree that, if the insurance policy should lapse or be canceled, I will neither receive nor be entitled to receive any further LRS referrals, and I will neither receive nor be entitled to receive any refund or relinquishment of any payments I have given or owe the LRS (whether as an application fee, panel fees, or otherwise).

  4. Arbitration: I agree to abide by all rules and regulations of the Santa Cruz County Lawyer Referral Service, including submission of any fee dispute arising between me and a client referred by the Service, if the client so elects, to binding arbitration through the State Bar of California Fee Arbitration Program.

  5. Rescheduling of Appointments: I understand that every attempt should be made by me to meet with the client per schedule. In the event of an emergency and the need to reschedule, I further understand that it is my obligation to give the LRS office a minimum of four-hours notice of any scheduling changes, and failure to do so may result in a review by the LRS Committee. Also, repeated cancellations or rescheduling of appointments may be cause for payment of lost referral fees to LRS by my office, and/or removal from LRS membership panels.

  6. Minimum Qualifications: Participation on all LRS panels is conditioned upon meeting the minimum qualifications or experience levels set forth in this application and Rules. I understand that I may petition for review if my application for a particular panel is denied or if I believe I am otherwise qualified to serve on this panel.

    Petitioners should submit: 1) a completed application; 2) declaration(s) in support from one or more attorneys who can explain why the applicant is qualified for the panel and agreeing to serve as a “sponsor” or in a support role during the applicant’s first year; 3) a letter from applicant describing how he or she will work with the sponsoring attorney to meet the needs of the LRS client while maintaining client confidentiality. Petitions will be reviewed on a case by case basis.

  7. Foreign Languages: The following foreign languages are spoken in my office:
    by myself by my staff
    Beginning Intermediate Advanced

  8. Disciplinary Proceedings: I have have not been subject to disciplinary proceedings by the State Bar of California or by any other Bar. If I have, an explanation is attached.

  9. Application Denial - Refer to Attachment B.5 and Attachment C.

  10. Fee Wavers: I agree to consult occasionally with clients who have received a Fee Waiver from LRS. Fee wavers are given to a limited number of financially pre-qualified clients each month.


C. FEES: ( *** Mid-year discount shown in shadow box below)
JOIN BETWEEN JULY 1, 2018 & DEC. 31, 2018: PAY FULL MEMBERSHIP & PANEL FEES (1 or 2 & include 3 below)

   1. MEMBERSHIP FEES FOR BAR ASSOC MEMBERS     $200.00
   2. MEMBERSHIP FEES FOR NON-BAR ASSOCIATION MEMBERS     $300.00
   3. PANEL FEES
$30 for each panel checked above / Except where "no panel fee" is indicated.
     $
TOTAL AMOUNT ENCLOSED**
    $
** JOIN BETWEEN January 1, 2019 & June 30, 2019: Take a 50% discount from #1, #2 and #3 above.

D. STATE BAR OF CALIFORNIA RULES & REGULATIONS PERTAINING TO LAWYER REFERRAL SERVICES INCLUDING MINIMUM STANDARDS FOR LRS IN CALIFORNIA:    Click Here to review State Bar Rules.

I have received from the LRS Office a copy of the Rules for the Lawyer Referral Service of Santa Cruz County, a copy of the Rules & Regulations of the State Bar of California Pertaining to Lawyer Referral Services including Minimum Standards for a Lawyer Referral Service in California (effective January 1, 1997) and a copy of the Business and Professions Code, Section 6155 et seq., Amended effective Jan 1, 1995.


E. PRO-BONO AND/OR LOW-FEE PROGRAM: (PLEASE CHECK #1 OR #2 BELOW)
  1. I will be available to handle:
    One pro-bono matter per year

       AND/OR

    One low-fee matter per year
    I further agree that I will pursue any such case(s) to conclusion.

          *      *      *

  2. I will not be available to handle any pro-bono or low-fee matters

BE SURE TO ENCLOSE A COPY OF YOUR CURRENT MALPRACTICE INSURANCE WHICH SHOWS POLICY AMOUNTS AND EXPIRATION DATE.

*            *            *            *            *

PLEASE GIVE DIRECTIONS TO YOUR OFFICE THAT WILL ENABLE CALLER TO MORE EASILY LOCATE YOUR OFFICE (Renewing Members Do Not Need To Fill This Out):


Please review your application carefully then click the submit button below to send your application information. Payment for your membership is by check or credit card. After you submit the form you will have the option to pay by credit card or the address for check payment.