2021 LCBA Membership Renewal Form

If you wish to print and mail your application with a check, please Click Here

Membership Renewal Form for 2021

Member's Name*
First Last
Membership Status*
Please choose the option that best describes you.
- Active Member Admitted to Practice 2018 - 2020 - $50.00
- Active Member Admitted to Practice 2017 and before - $100.00
- Retired and Inactive Member - $50.00
Year admitted to practice in Ohio:*
Year joined Licking County Bar Association:
Ohio Supreme Court Registration Number:
Firm Name
Committee preferences: (If different from last year’s assignment)
Post Office Box and Street Address*
Street Address Address Line 2 City State ZIP Code
Email*
Please choose one of the following options regarding your email address.*
- I AGREE to have my email address provided to other LCBA members if requested.
- I DO NOT AGREE to have my email address provided to other LCBA members if requested.
How Would You Like To Pay?*
- Pay Online
- Mail A Check
Make checks payable to:
Licking County Bar Association
Remit payment to:
David Skrobot
Fisher, Skrobot and Sheraw
471 East Broad Street
Suite 1810
Columbus, Ohio 43215
Check Number*
Check Date*
Check Total*
Your check should be for the amount next to the option you chose for your Membership Status above
(plus a $10 reinstatement fee if applicable).
You will receive a receipt from PayPal after your payment has been made.
Membership Dues*
Please choose the option that best describes your status.
Do you owe a Reinstatement Fee*
Dues are payable by January 1, 2021. If dues are not paid by January 31, 2021, you will no longer be a member, you will no longer receive notices and your name will be removed from the LCBA website. After January 31, 2021, you may reinstate your membership by paying your dues plus a $10 reinstatement fee. Fees will not be prorated.
- Yes
- No
Reinstatement Fee
Price: $10.00
Total
$0.00
Phone
This field is for validation purposes and should be left unchanged.

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Welcome to the Licking County Bar Association

Membership Renewal Form for 2021

Make checks payable to:

Remit payment to:

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