On Demand Law Practice Startup Workshop Registration
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Only fields marked with an asterisk(*) are required. Please complete this entire form if you haven't provided the information to us already on a previous signup form. If you've completed an intake before, please just update any new information you might have to keep our records current.
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Please select your position in the Massachusetts legal community. (LCL MA services are exclusively for Massachusetts.)
Please select...
Licensed to practice in Massachusetts (or formerly licensed in MA)
Pending admission to practice in Massachusetts
Attending a Massachusetts law school
Living in Massachusetts while attending law school remotely
Legal professional in Massachusetts
First Name
Last Name
Nickname?
Pronouns
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She/Her/Hers
He/Him/His
They/Them/Theirs
No pronoun, use name only
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Email Address
CONTACT INFORMATION
Home Phone
Number only, don't include dashes
Work Phone
Mobile Phone
Best method to reach you is:
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Mobile Phone
Home Phone
Work Phone
Email
Street Address
City
State
Zip
County
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Barnstable
Berkshire
Bristol
Dukes
Essex
Franklin
Hampden
Hampshire
Middlesex
Nantucket
Norfolk
Plymouth
Suffolk
Worcester
DEMOGRAPHIC INFORMATION
Responses are NOT required.
We ask for the information below for statistical purposes and to measure our organization's reach. We keep all information confidential and secure.
Sex
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Female
Male
Non-Binary
Prefer to Self-Describe
Other
Prefer Not to Answer
If other sex, option to specify:
Birthdate
Required format: MM/DD/YYYY
Race & Ethnicity (You can select multiple.)
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Asian
Black or African
Hispanic or Latinx
Jewish
Native American
Pacific Islander
White
Other
Prefer Not to Answer
If other race/ethnicity, option to specify:
Do any of the following LGBTQ+ categories apply to you?
(You can select multiple.)
Please select...
Gay or Lesbian
Bisexual
Trans
Queer
Other
Prefer Not to Answer
If other LGBTQ+ category, option to specify:
Have you been diagnosed with a disability or do you identify as having a disability?
Yes
No
Prefer Not to Answer
Optional space to specify the disability or disabilities:
Bar Admission Status
Please select...
Admitted In Good Standing
Pending
Retired
Inactive
Failed Bar Exam
Diversion
Suspended for less than 1 year
Suspended more than 1 year
Disbarred
Disbarred or Suspended with leave to perform paralegal work
Readmitted
Monitored Probation
Not Admitted
Law School
Graduation Year
Employer Type
Please select...
Solo Practice
Small Practice (2-10 attorneys)
Medium Practice (10-30 attorneys)
Large Practice (30 or more attorneys)
Government or Nonprofit
Corporate or In-House
Temporary or Contract
Law Student
Non Legal Job
Retired
Unemployed
Law School Faculty/Staff
Judge
Clerk/Courthouse Staff
Other
How did you hear about LCL | Mass LOMAP? Please check all that apply.
Bar Association
Board of Bar Examiners
Board of Bar Overseers
Client
Colleague, Friend, or Family
CPCS
Employer
Exhibitor Table at Event
Internet Search
Judge/Judiciary
Law School
LCL | Mass LOMAP Staff
Mass Lawyers Weekly
Other:
Practicing with Professionalism
Presentation by
LCL | Mass LOMAP Staff
Print Advertisement
Read Article by
LCL | Mass LOMAP Staff
Recovery Meeting
SJC Standing Committee on Lawyer Well-Being
Social Media
Treatment Provider
Web Advertisement
If other, please specify:
Name of individual referral source, if desired:
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Questions or concerns? Email rachel@lclma.org or call 857-383-3250.
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