Join the Advocacy Attorney Network

Learn more about the Advocacy Attorney Network at: http://www.diabetes.org/attorneyswanted


First Name
Last Name
Address
Address 2
City
State
Zip Code
Your Professional Website (or LinkedIn)
Place of Business
Email Address
Home Phone (optional)
Work Phone
Mobile Phone
1. In which states(s) are you licensed to practice law?
2. In which states in which you are willing to volunteer as a Network Member?
3. What is your practice setting?
4. What types of law do you practice? Select all that apply.  
Other (please specify)  
5. What specific discrimination law experience do you have? Please note: experience in discrimination law is appreciated, but not necessary. Select all that apply.
 
5a. Other: List your other specific discrimination law experience:  
6. Do you provide legal services in languages other than English?  
If yes, please list additional language(s) in which you provide legal services:  
7. In which of the following areas are you interested in providing service, as a Network Member? Select all that apply.  
8. In which of the following functions are you interested in providing service, as a Network Member? Select all that apply.  
9. Are you able to provide a free consultation to individuals referred to you by the Association?  
10. In general, after initial consultation, what fee structure(s) are you able to consider? Select all that apply.  
Other fee structure options:  
11. How did you learn about the Advocacy Attorney Network?  
Other (please specify):  
12. What was the primary motivation for you to become a member of the Advocacy Attorney Network?  
Other (please specify):  
13. How have you have been involved with the American Diabetes Association? Select all that apply.  
13a. Other: List other ways you have been involved with the American Diabetes Association:  
14. The Advocacy Attorney Network Listserv provides a valuable forum for robust discussion about discrimination due to diabetes. If you prefer that we add a different email address than the one you provided above, please list it here:  
   
15. When you join the Advocacy Attorney Network, you also become a Diabetes Advocate; you will regularly receive urgent Action Alerts and information about how you can help Stop Diabetes through advocacy.  
   
16. If you want to recommend a colleague for us to contact for recruitment into the Advocacy Attorney or Health Care Professional Legal Advocacy Network, please list their name(s), email address(es), and professional title(s).

 
 I have questions and would like to speak with a staff member before I sign up as a Network Member.

I am ready to sign up now.