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First Name	Last Name
Attorney #	Nick name
Firm
Address 1	Address 2
City	State AK AL AR AS AZ CA DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TT TX UT VA VI VT WA WI WV WY	Zip
County	County of Residence	Email
Phone	Fax
First Year in Practice	Number of Years in Practice

Practice Areas/Committees (Optional)
Business LitigationConstruction LawDiversity
Employment LawHealth Law LitigationInsurance Coverage
Product LiabilityTrial TacticsWomen in the Law
Workers' Comp

For Voting Members

Do you devote more than 50% of your time to the representation of individuals seeking to recover damages for bodily injury and/or property damage against defendants?	YESNO
Do you devote a substantial portion of your professional practice in the defense of claims, actions, or suits against individuals, companies, corporations, or agencies?	YESNO
I am a member of the Indiana Trial Lawyers Ass'n OR the American Trial Lawyers Ass'n. If you are a member of either ITLA or ATLA, please explain why you believe you qualify for membership in DTCI:	YESNO

For Non-Voting Members (non-lawyers)

Number of years employed by insurance company or affiliated organization
Number of years involved in company's litigation activities
If not involved in company's litigation activites, list activities compatible with purposes of this association: Sponsor a current DTCI member
Are you a current DRI member?	YESNO
If you have never been a member of DRI, would you like to join DRI and receive free registration for one seminar in your first 18 months?	YESNO
Download and submit new DRI membership requests: DRI Membership Request

I AGREE to abide by the by-laws of this Association and am willing to work on behalf of the DTCI and defense bar. I understand that my membership is provisional until final approval is given by the Board of Directors.

There is a built-in $50 Application Fee included in the membership price

$100.00 -- In practice as a Government Attorney
$130.00 -- In practice less than three years
$250.00 -- In practice more than three years
$25.00 -- Paralegal

We are required to notify you that 18% of your dues is not deductible as an ordinary and necessary business expense for the current tax year because that portion is used to support lobbying. $19 of your dues is for a one-year subscription to the Indiana Lawyer, unless you are a member of the IBA.

Payment Options
Credit Card -- Your card will be charged immediately. A refund will be issued if your membership is not approved.
Check -- You will be sent a confirmation email to sign and return with your check.