Membership Type

Select:		Choose One... Attorney ($249.00) Paralegal ($100.00)
		I hereby certify that not more than 25% of my practice is dedicated to representing insurance companies and their insureds in civil litigation matters.

Member Information

Title:		Choose One... Mr. Mrs. Ms. Dr.
First Name:
Initial:
Last Name:
Years In Practice:
Florida Bar Number:
Trial Attorney References:		* * *List two, one must be an active PBCJA member.

Mailing Address

Firm Name:
Firm Address 01:
Firm Address 02:
City:
County:
State:
Zip:
Telephone:
Fax:
Email Address:
Website:

Trial Talk



To renew your subscription to Palm Beach County Trial Talk check the boxes below. Trial Talk is a free service provided by the PBCJA to its members.

		Yes, I would like to join Trial Talk.
		I hereby certify that in personal injury matters, me and my firm does 0% insurance defense work. I further agree not to share any information on Trial Talk with anyone that is not a member of Trial Talk.

Contribution



If you wish to make a voluntary contribution to the PBCJA at this time in addition to your regular membership dues then please select the amount in the box below.

Contribution:

Select . . . $25.00 $50.00 $75.00 $100.00 $150.00 $200.00 $250.00 $300.00 $350.00 $500.00

PBCJA.org Account



Please enter your username and password in order to gain access to members only areas of PBCJA.org.

Username:
Password:
Re-enter Password:

Print Membership Form






Return the form with payment to:

Palm Beach County Justice Association
P.O. Box 3515
West Palm Beach, FL 33402