PARTICIPATING ATTORNEY SIGN-UP FORM *NAME: FIRM: *ADDRESS1: ADDRESS2: *CITY/STATE/ZIP:
, *STATE:
*ZIP:
*EMAIL: *PHONE:
(
*Fax:
)
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) * Required fields
AREAS OF PRACTICE IN WHICH YOU’RE WILLING TO HELP: Consumer/Finance Education Employment Family
Housing Income Maintenance Individual Rights Juvenile
Health
Other
OPTIONS IN WHICH YOU ARE INTERESTED: Traditional Participating Attorney List Direct Referral from Judicare Staff Special Projects General Volunteers
Pro Bono
Compensated
COUNTY(IES) IN WHICH YOU ARE INTERESTED IN PROVIDING ASSISTANCE: Ashland Barron Bayfield Burnett Chippewa
Clark Douglas Dunn Eau Claire Florence
Forest Iron Langlade Lincoln Marathon
Marinette Menominee Oconto Oneida Pepin
Pierce Polk Portage Price Rusk
Sawyer Shawano St. Croix Taylor Vilas
Washburn Waupaca Wood
ADDITIONAL COMMENTS:
Please fax completed form to Pro Bono Director Marka Henkelman’s attention at (715) 848-1885 or email to
[email protected]. Someone will contact you within 5 business days to discuss your options and preferences. Wisconsin Judicare is not responsible for emails or email forms not delivered due to security settings, SPAM filters, etc. If you do not receive a reply, please contact us via U.S. Mail at P.O. Box 6100, Wausau, WI 54402-6100 or call us at (715) 842-1681. Please do not use this form or our email address to solicit products or services.
