Thank you for your willingness to assist at this time of human tragedy and catastrophic destruction. Please complete the brief form below to indicate your interest in assisting with the legal needs that will face Katrina evacuees in Michigan. This information will be shared with the local pro bono programs in your geographic area. View the list of programs or see a statement of Michigan’s Voluntary Pro Bono Standard.
By checking this box, I agree that my participation in any hurricane relief activity related to a referral from this database will be done pro bono.
Full Name:
Member P#:
Company Name:
Address:	Street:
	City:		State:	ZIP:
	Country:
Contact Information:	Phone:
	Email:
Best method for immediate contact:		e-Mail Phone
Counties in which you practice law:
Practice Area(s):	Check all that apply	Child Welfare Community Economic Development Consumer Finance (Lending/Credit/Bankruptcy) Consumer Protection Criminal Law Education Employment/Unemployment Benefits Family Law Health Issues Immigration Insurance Real Estate Small Business Issues Taxation Welfare/Public Benefits Will/Probate Other, Please Specify:
Interested in assisting in the following areas:	Check all that apply	Meeting with evacuees and assessing their legal situation Preparing referral paperwork with detailed descriptions of legal issues Mediating/Negotiating Issues General Representation Assisting in development of Michigan Legal Disaster Plan
Privacy Statement All information collected in this database will be used exclusively for the purpose of providing legal resources to the efforts to aid Hurricane Katrina evacuees in Michigan. This information may be provided to a party outside the State Bar of Michigan, but its use will be restricted exclusively to the purpose stated above. This information will not be sold or used for any marketing purposes by the SBM or any party to whom it is provided.