Attorney Application

Erie County Bar Association Aid to Indigent Prisoners Society, Inc
Assigned Counsel Program
The Brisbane Building
403 Main Street Suite 215
Buffalo, NY 14203

Phone: 716-856-8804
Fax: 716-856-0424
Email: amy.brown@assigned.org
Website: www.assigned.org

First Name *

Last Name *

SSN *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Cell Phone Number

Fax Number

Email Address

Calendar year of admission to practice in New York State *

Briefly describe the nature of current and recent past practice, e.g. home office, shared space, who you work for/with, etc.

I am interested in joining *

Criminal Panel

Family Panel

Both

All payments will be to the assigned attorney, not the attorney's firm.

1099 Forms will also be prepared for each individual attorney.

Panel attorneys are independent contractors and are not employees of the Assigned Counsel Program.

Please upload your resume here

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