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Legal Aid Alberta - Roster Application Form
General Information
Type of Account
*
Select
Lawyer
Assistant
Student-at-Law
Personal Information
Please identify other names you may have used with Legal Aid Alberta using the Alias Name text boxes. This will assist Legal Aid staff in determining whether or not you have been on the LAA Roster in the past as a Lawyer or an Assistant to a Lawyer.
Last Name
*
*
First Name
*
*
Middle Name
*
Gender
*
Select
Male
Female
Other
Alias Name
*
Alias Name
*
Lawyer Information
Firm’s GST Registration Number
*
Alberta Law Society Number
*
Alberta Year of Call
*
Student Information
Name of Principal
*
Firm Email Address
*
*
Year of Admission (or Expected) to Alberta Bar
*
Contact Information
Firm Name
*
*
Work Number
*
*
Work Number Extension
*
Mobile Number
*
Email
*
*
*
Preferred Method of Contact
*
Select
Any
Email
Phone
Fax
Mail
Address 1
*
*
City
*
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Address 2
*
Province
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Address 3
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Postal Code
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