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Legal Aid Alberta - Roster Application Form

General Information

Type of Account

Personal Information

Last Name

*

First Name

*

Middle Name

*

Gender

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

Address 1

*

City

Address 2

*

Province

Address 3

*

Postal Code

*

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