34 Defense Comment Summer 2019 ASSOCIATION OF DEFENSE COUNSEL OF NORTHERN CALIFORNIA AND NEVADA Membership Application NAME:_________________________________________________________________________________________________________ FIRM:_______________________________________________________________________________________________________ ADDRESS: ________________________________________________ CITY/STATE/ZIP:______________________________________ TELEPHONE:______________________________________________ BIRTHDATE(yearoptional):_____________________________ FAX:_____________________________________________________ NAMEOFLAWSCHOOL:________________________________ E-MAIL:__________________________________________________ YEAROFBARADMISSION:______________________________ WEB SITE:_________________________________________________ BAR NUMBER:_______________________________________ Number of Years: Associated with Firm?_______________ Practiced Civil Defense Litigation? ______________ Are you currently engaged in the private practice of law?  Yes  No Do you devote a significant portion of your practice to the defense of civil litgation?  Yes  No Practice area section(s) in which you wish to participate (please check all that apply):  Business Litigation  Health Care  Public Entity  Young Lawyer  Construction Law  Insurance Law and Litigation  Toxic Torts  Employment Law  Landowner Liability  Transportation MEMBERSHIP into the Association of Defense Counsel of Northern California and Nevada is open by application and approval of the Board of Directors to all members in good standing with the State Bar of California or Nevada. A significant portion of your practice must be devoted to the defense of civil litigation. I Was Referred By:________________________________________ ______________________________________________________ Name Firm Signature of Applicant:________________________________________________________ Date:_________________________ Contributions or gifts (including membership dues) to ADC are not tax deductible as charitable contributions. Pursuant to the Federal Reconciliation Act of 1993, association members may not deduct as ordinary and necessary business expenses, that portion of association dues dedicated to direct lobbying activities. Based upon the calculation required by law, 15% of the dues payment only should be treated as nondeductible by ADC members. Check with your tax advisor for tax credit/deduction information. MEMBERSHIP FEES: Annual dues for ADC membership are based on your type of defense practice (staff counsel or independent counsel) and, for independent counsel, the length of time in practice and the number of ADC members in your firm. The following are the base fees:  Regular Members: $325 Independent Counsel in Practice for More Than Five Years  Young Lawyers: $200 In Practice 0-5 Years  Associate: $250 Staff Counsel of Government and Corporate Entities (regardless of the number of years in practice) PAYMENT:  Check Enclosed (Payable to ADCNC)  Please Bill My MasterCard/Visa Last 4 Digits of Card:______________ Name on Card:__________________________________ Cardholder Signature:_________________________________________ Address (if different from above):________________________________________________________________________________ Full Card Number:____________________________________________________________ exp:___________ CVV#:__________ Do not e-mail credit card information. Please fax or mail this form with your payment to: Association of Defense Counsel of Northern California and Nevada 2520 Venture Oaks Way, Suite 150, Sacramento, CA 95833 • (916) 239-4060 - phone • (916) 924-7323 - fax • www.adcnc.org 6/18/19