• Lawyer Referral Service Membership Application

    326 Monroe Street, P.O. Box 119
    Jefferson City, MO 65102
    Phone: (573) 636-3635 
    Fax: (573) 635-2811

    The Missouri Bar Lawyer Referral Service links clients to lawyers throughout Missouri, except for St. Louis City and St. Louis County, and Springfield (Greene County). In those areas, people needing attorneys rely on the local bar association lawyer referral service.

    Please provide the following contact information:

    Attorney Name:  
    Bar Number:  
    Firm Name:  
    Address:    
    City:  
    State:  
    Zip Code:  
    County:  
    Office Phone:  
    Extension:  
    Fax Number:  
    Email:  
    Website Address:  



    Law School Graduated From:  
    Year Graduated:  
    Year admitted to practice in Missouri:  
    Other states or jurisdictions where you are admitted to Practice:  
    Other Professional Degrees & Licenses:    
    Installment Payments possible after initial consultation:
                           

    Home Visits Possible:  
                           
    Evening Appointments:  
                           
    Weekend Appointments:  
                           
    Is Office Handicapped Accessible:  
                           
    Foreign Languages in which I am reasonably fluent:  
    Please list the counties for which you are willing to receive referrals:  

    Policy Agreement

    I represent that I am licensed to practice in Missouri, that I am covered by a Professional Liability Insurance policy with limits of not less than $100,000/$300,000 and that I will maintain this policy throughout the period of my participation in the service. (see Rule IV.D.(3).)

    I further state and agree that the staff person who receives a request for referral which I ultimately accept is acting as my employee and/or agent and shall be bound by the attorney-client privileged communication rule regarding any information which is communicated to such person during the process of referral.

    I am associated with the law firm . I am authorized by my law firm to seek membership in The Missouri Bar Lawyer Referral Service (“the Service”) and to bind my law firm to the rules of the Service. I and my law firm agree to be bound by the rules of the Service, including the requirement that any fees earned by my firm for a client referred to me or my law firm by the Service must be shared with the Service under those rules. Should my law firm association change, I will promptly notify the Service which attorney or law firm will continue to represent any clients referred to me or my law firm by the Service. Such a change will not alter my duty to share in any fees earned from the referred client. 

    I will abide by all the rules and regulations of the Missouri Bar Lawyer Referral Service.  

    Liability Insurance Carrier:  
    Policy No:   

      

    NOTICE: Effective June 15, 2014, in our effort to provide discounted services to veterans, The Missouri Bar Lawyer Referral Service will provide veterans a 25% discount off our $50.00 administrative fee.  Veterans will be charged $37.50. Participating attorneys who are members of the Service may also provide a 25% discount on their regular, customary rates.

    By checking this box, you are agreeing to provide veterans referred to you through the Service, a discount of 25% off your regular, customary rates.



     
    Checked are the areas in which I will accept referrals: