Contact Information
Name:
Firm:
Address:
Phone:
Fax:
Email:
Professional Information
Bar Admissions:
Professional Affiliations:
Check all the apply:
I am a pension lawyer and my areas of practice are:
ERISA/Private Pension (PP)
Multi-employer Pension (MP)
Government Pensions (GP)
I am a domestic relations lawyer with expertise in related pension matters (DR)
I have expertise in the following areas related to pensions:
Employment Discrimination/Labor Law (ED)
Health Care/COBRA (HC)
Social Security, Disability (SS)
Railroad Retirement (RR)
Veterans Benefits (VB)
Please provide any other information about areas of practice or types of referrals you are willing to take:
Level of Participation
I am willing to: (check all that apply)
Advise participants of their legal rights
Represent participants in plan claims proceedings
Represent participants at trial
Represent participants in appellate litigation
Represent a spouse in a domestic relations case
Provide technical assistance to other lawyers
Other (please specify)
I am willing to accept referrals from the National Pension Lawyers Network under the following fee arrangements: (check all that apply)
Pro Bono Reduced Fee Regular Fee
Fee For Initial Consultation:
Other Fee Information:
Please include any other information that would be helpful in making appropriate referrals.
Signature Date
Please return this form to: National Pension Lawyers Network, Gerontology Institute, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125 by mail, fax (617-287-7080)
 
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Last modified: March 18, 2002