United States Courts
SEQ CHAPTER \h \r 1UNITED STATES DISTRICT COURTEASTERN DISTRICT OF LOUISIANAATTORNEY REGISTRATION STATEMENTPursuant to Local Rule 83.2.2 of the United States District Court for the Eastern District of LouisianaTITLEMr. _____Mrs.______Miss._____Ms.______LA Bar No.___________NAME ____________________________________________________(Last)(First)(Middle)FIRM NAME_______________________________________________OFFICE ADDRESS __________________________________________________________________________RESIDENCE ADDRESS __________________________________________________________________________BUSINESS TELEPHONE NUMBER________________________FAX NUMBER_____________________________________List below the Bars of all states, territories, districts, commonwealths or possessions or other courts of the United States to which you are admitted to and the dates of such admissions:BarsDates_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________DateSignatureNOTE: A Supplemental statement of any changes in the foregoing information shall be filed within 30 days of such change.Rev 4/11 ................
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