New member registration | Massachusetts Lesbian and Gay Bar Association

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First name*:

Last name*:

Organization:

Mailing Address:

Note: Contact Information will not be published in the Members Directory.

Address Line 1*:

Address Line 2:

City*

State, Province*:

Postal Code:

Business Address:

Same as mailing address

Note: Business contact details will be published in the Members Directory.

Address Line 1:

Address Line 2:

City:

State, Province:

Postal Code:

Contact Telephone Number*:

Work Telephone Number:

Work Fax:

Weblink:

OK to leave message at Home?

OK to leave message at Work?

PREFER being contacted at:

OK to receive email about
MLGBA news/events?

CURRENT MBA MEMBER?

CURRENT NLGLA MEMBER?

Include my information in MLGBA PRINT DIRECTORY

Include my information in MLGBA ONLINE DIRECTORY

MENTOR PROGRAM:
I am interested in participating in the Mentoring Program as a:

Mentor

Student

New Lawyer (Mentee)

SECTIONS:

Estate planning:	Immigration:	Employment law:
Plaintiff�s Tort:	Family law:	Western MA:
IP/Technology:	Solo Practitioner:	Bankruptcy:

COMMITTEES:

Membership:	Outreach:	Events:
Dinner:	Communications:	Legislative:
Technology:	History:	Education:
Transgender Inclusion:

Sliding Dues Scale:

If you wish to receive a subsidized, electronic subscription to Lesbian & Gay Law Notes, please enclose:

$0 if you are an attorney contributing $50 or more in membership dues.
$10 if you are an attorney contributing less than $50 in membership dues.
$5 if you are a law student.

Tax Information: Membership dues are not deductible as a charitable contribution for income tax purposes, but may be deductible in part as a business expense. MLGBA estimates that 15% of your total membership dues is allocable to lobbying activities of the Association, and therefore is not deductible for income tax purposes as ordinary and necessary business expense.

E-mail address*:

Password*:

Confirm password*:

Type of Payment:

Total:

Name on Card*:

Card Type*:

Card Number*:

Card Code*:

Expiration Month*:

Expiration Year*: