Butler County Bar Association

2025 Lawyer Referral Service (LRS) Application

Attorney Information Name: Supreme Ct. No: Office Address: What days/hours is office staffed? Branch office location(s): What days/hours is branch staffed? Office phone: Cell phone: Fax: E-mail: Website: Year admitted to Ohio Bar: Law School: Graduation Date: Your professional liability carrier: Policy #: Exp date:

Terms for acceptance as an LRS Attorney Participant:

Participation in the LRS is on a subscription basis. Monthly or annual subscriptions are available.

Subscription Type: For monthly subscriptions For annual (12 consecutive months) subscriptions

LRS Committee Approval Date signed:

YES! I want to participate in the Butler County Bar Association Lawyer Referral Service Program.

Subscription Options Basic Monthly Subscriber at $35.00 per month Premium Monthly Subscriber at $50.00 per month Basic Annual Subscriber at $359.00 per year. SAVE 15% Premium Annual Subscriber at $499.00 per year. SAVE 17%

Payment

Payment Information First Name (on card) Last Name (on card) Address City State ZIP Code Country Phone # Email Address Credit Card Type Credit Card Number Expiration Month Expiration Year CVV

Your Signature: Date:

Butler County Bar Association

2025 Lawyer Referral Service (LRS) Application

Payment

The Butler County Bar Association© charges a 3% processing fee on all credit card payments.