INTERNATIONAL AMUSEMENT & LEISURE DEFENSE ASSOCIATION, INC. INDICATE MEMBERSHIP STATUS DESIRED __ ACTIVE MEMBER __ASSOCIATE MEMBER 1. LAST NAME_______________________FIRST NAME_____________________MIDDLE NAME_________________ ADDRESS______________________________________________________________________________________ CITY___________________STATE__________ZIP___________DATE OF BIRTH_________________________ 2. FIRM/EMPLOYER'S NAME________________________________________________________________________ ADDRESS______________________________________________________________________________________ CITY__________________STATE___________ZIP________ TEL#____________________ FAX_________________ 3. YOUR TITLE AND DUTIES_________________________________________________________________________ 4. DESCRIBE YOUR INVOLVEMENT IN AMUSEMENT/LEISURE INDUSTRY LEGAL AFFAIRS:______________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 5. LIST YOUR CURRENT BAR, DEFENSE OR AMUSEMENT INDUSTRIES' TRADE ASSOCIATION MEMBERSHIPS:_ _______________________________________________________________________________________________ ________________________________________________________________________________________________ 6. WHAT AMUSEMENT/LEISURE INDUSTRIES' TRADE CONVENTIONS, MEETINGS OR SEMINARS HAVE YOU ATTENDED?_____________________________________________________________________________________ ________________________________________________________________________________________________ 7. HOW DO YOU EXPECT TO BENEFIT FROM YOUR MEMBERSHIP IN THE IALDA?___________________________ ________________________________________________________________________________________________ 8. WHAT CAN YOU CONTRIBUTE TO THE IALDA?_______________________________________________________ ________________________________________________________________________________________________ 9. WHAT PERCENTAGE OF YOUR PROFESSIONAL TIME DO YOU DEVOTE TO THE LEGAL AFFAIRS OF THE AMUSEMENT AND LEISURE INDUSTRIES?___________________________________________________________ 10. LAW SCHOOL AND YEAR OF GRADUATION________________________________________________________ 11. STATE WHERE YOU ARE ADMITTED TO THE BAR AND YEAR OF ADMISSION____________________________ _______________________________________________________________________________________________ 12. STATES OR FEDERAL JURISDICTIONS WHERE YOU AND YOUR LAW FIRM REGULARLY PRACTICE________ _______________________________________________________________________________________________ 13. HOW MANY TRIALS INVOLVING THE AMUSEMENT AND LEISURE INDUSTRY HAVE YOU PERSONALLY TRIED TO A CONCLUSION DURING THE PAST FIVE YEARS?_________WHICH JURISDICTIONS?___________________ ________________________________________________________________________________________________ 14. WHAT TYPES OF CLIENTS IN THE AMUSEMENT INDUSTRY DO YOU REGULARLY DEFEND AND/OR REPRESENT? (E.G. WATERPARKS, ROLLER RINKS, MANUFACTURERS, SUPPLIERS, ETC.)_________________ ________________________________________________________________________________________________ 15. ARE YOU NOW REPRESENTING OR HAVE YOU EVER BEEN RETAINED BY OR REPRESENTED AN INJURED CLAIMANT AGAINST A MEMBER OF THE AMUSEMENT OR LEISURE INDUSTRY? ( ) YES( ) NO IF YES, DESCRIBE THE CASE, STATE THE NAME OF THE DEFENDANTS._________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 16. PLEASE PROVIDE A REPRESENTATIVE LIST OF YOUR CLIENTS IN THE AMUSEMENT/LEISURE INDUSTRY: _______________________________________________________________________________________________ ________________________________________________________________________________________________ 17. LIST THE INSURANCE COMPANIES, ASSOCIATIONS OR CORPORATIONS (NOT LESS THAN THREE) WHO KNOW OF YOUR INVOLVEMENT IN THE INDUSTRY OR FOR WHOM YOU HAVE WORKED WITHIN THE PAST FIVE YEARS. NAME AND ADDRESS OF INSURANCEPERSON TO WHOM COMPANY OR OTHER ORGANIZATIONINQUIRIES TO BE ADDRESSED _____________________________________________________________________________________ _____________________________________________________________________________________ AddressZipcodeTitle _____________________________________________________________________________________ _____________________________________________________________________________________ AddressZipcodeTitle _____________________________________________________________________________________ _____________________________________________________________________________________ AddressZipcodeTitle 18. LIST THE COMMITTEES THAT YOU WANT TO SERVE ON:_____________________________________________ _______________________________________________________________________________________________ IF ELECTED TO MEMBERSHIP, I AGREE BY THE BY-LAWS AND CODE OF CONDUCT OF THE IALDA AND TO IMMEDIATELY NOTIFY THE IALDA OF ANY CHANGES IN MY STATUS THAT WOULD AFFECT MY QUALIFICATIONS AS A MEMBER OF THIS ORGANIZATION. Dated:___________________, _______________________________________________________________ Signature of Applicant *PLEASE ATTACH A COPY OF YOUR RESUME OR BIOGRAPHICAL SKETCH TO THIS APPLICATION* **PLEASE PROVIDE THE NAMES AND ADDRESSES OF ANYONE ELSE WHO MIGHT WANT TO JOIN THE IALDA** Send To: David J. Daly,Esquire Daly Cavanaugh, LLP 27 Mica Lane Wellesley, Massachusetts 02481 Tel:781-237-0600 Fax: 781 237 6010 |
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