• Lawyer Referral Service Membership Application

    326 Monroe Street, P.O. Box 119
    Jefferson City, MO 65102
    Phone: (573) 635-4128
    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 will abide by all the rules and regulations of the Missouri Bar Lawyer Referral Services.

     

    Liability Insurance Carrier:  
    Policy No:  
     

    Please specify any additional areas or explain any "restrictions" or any other information that would be helpful in referring clients to you.