By in-house counsel, for in-house counsel.

Membership Application
CODE: 12345

1025 Connecticut Avenue, NW, Suite 200 Washington, DC 20036-5425 USA tel +1 202.293.4103 x 360; fax +1 202.293.2003 membership@acc.com ACCE contact: acceurope@acc.com http://www.acc.com/chapters/euro
(Check one) First Name Title Organization name Mailing address City State/Province Telephone Email U.S. State(s) or Country(ies) in which admitted Law school Briefly describe your primary duties: Zip/Postal Code Mr. Mrs. Ms. Miss

To contact ACC, write, call, or email: Membership Department

Submission of this application constitutes agreement to abide by the Associations bylaws: I understand that membership is limited to attorneys who actively practice inside a corporation or other private sector organisation, and do not hold themselves out to the public for the practice of law. This precludes individuals whose responsibility includes selling or providing services to individuals and organisations who are not their employer. Submission of this application also creates an explicit opt-in to the use and distribution of some personal data otherwise protected from publication by the privacy laws of some countries. See ACCs privacy statement for a complete understanding of the limited and internal uses of your membership information inherent in your agreement to join the Association.* The User ID and password assigned to you as an ACC member may only be used by you. Signature

Communications/Mailings

Middle Initial

Nickname

Last Name

Occasionally, we may make your name available to other organizations offering products and/or services that may interest you. If you prefer not to receive these mailings, check the box below. We never share phone, fax or email information. I do not wish to receive non-association mail.
How did you learn about ACC?

From a colleague. Name Mail from ACC Magazine or newspaper story ACC homepage or other internet source
Demographics

Attended local Chapter event Attended Annual Meeting In law school Other _____________________

Country

Fax

Your answer to this section is optional. The use of this information is restricted to ACC and is being requested to enhance ACCs continuing efforts to reflect diversity within its programs, activities, and leadership. It will not be provided to any external individual or organization except in summary form. Asian/Asian American/Pacific Islander Year graduated Latino/Hispanic African American/Black Native American/Native Alaskan White/Caucasian Multi-Racial Male Female

ACC dues are not deductible as a charitable contribution for federal tax purposes, but may be deductible as a business expense. Membership is for one year. An ACC Docket subscription is an automatic and non-severable benefit of membership. $50.00 is allocated for the magazine subscription. Annual Dues Annual dues are $260 (in U.S. dollars) per person. Includes chapter and committee memberships. Chapter assignments are automatically based on location.

Parent companys name __________________________ Date of birth (MMDDYY) ________________________ Please send me information on pro bono activities.
Committees

Please select the Committees you wish to join (free to members; unlimited selection). Compliance & Ethics Corporate & Securities Law Employment & Labor Law Energy Environmental, Health & Safety Financial Services IT, Privacy & eCommerce Insurance Staff Counsel
11/08

Please check payment method (in U.S. dollars) Organizational check enclosed Personal check enclosed Charge my: VISA Mastercard American Express Exp. Date (MMYY)

International Legal Affairs Intellectual Property Law Department Management Litigation New to In-house Nonprofit Organizations Real Estate Law Small Law Departments

Account number Printed name Signature

*Complete privacy statement online at http://www.acc.com/aboutacc/legal.cfm

By in-house counsel, for in-house counsel.

Targeted Practice Information

Please complete the following questionnaire so that we can send you targeted practice information relevant to your career stage.
NUMBER OF YEARS WORKING AS IN-HOUSE COUNSEL?

12 years 35 years 610 years 1115 years 1620 years 21 +

TITLE WHICH BEST DESCRIBES YOUR POSITION

Chief Legal Officer/GeneralCounsel Division Counsel Deputy General Counsel

PRIMARY PRACTICE AREA

Assistant/Associate GeneralCounsel Supervisory Assistant/Associate GeneralCounsel Non-supervisory Managing Attorney (New)

Managing Attorney ( 3+ years) Senior Attorney Staff Attorney Other

Commercial Law Compliance & Ethics Corporate, Securities & Governance Employment & Labor Energy/Public Utility Environmental Law
INDUSTRY

Financial Services Government Insurance Intellectual Property International Law Department Adminstration

Litigation Media/Publishing Real Estate Technology

Accommodation & Food Services Administrative and Support & Waste Agriculture, Forestry, Fishing, & Hunting Arts, Entertainment & Recreation Construction Educational Services Energy, Oil & Gas Finance and Insurance Health Care & Social Assistance

Information Technology Management and Remediation Services Management of Companies & Enterprises Manufacturing Mining Pharmaceuticals Professional, Scientific &Technical Services Public Administration Real Estate & Rental /Leasing

Retail Trade Telecommunications Transportation & Warehousing Utilities Wholesale Trade Other

NUMBER OF ATTORNEYS IN YOUR LEGAL DEPARTMENT (INCLUDING YOURSELF & ALL COUNSEL AT ALL LOCATIONS)

1 25 620 2150 years 51+

MY COMPANY IS

Public Private
MY COMPANY OPERATES IN

The US Europe Canada Asia Middle East Central/South America Other