12.2015
IN THE SUPREME COURT OF THE UNITED STATES VIRGIN ISLANDS
ACTIVE MEMBER ANNUAL REGISTRATION
Registration Type:
Name When Admitted (If Different): ____________________________________________________
Business Address (Physical): Address 1________________________________________________
Address 2________________________________________________
Address 3________________________________________________
City ______________________ State ____________ Zip__________
Business Address (Mailing): Address 1________________________________________________
Address 2________________________________________________
Address 3________________________________________________
City ______________________ State ____________ Zip__________
Business Email: __________________________________________________________________
Business Phone: _______________________ Business Fax: ___________________________
Home Address (Physical): Address 1________________________________________________
Address 2________________________________________________
Address 3________________________________________________
City ______________________ State ____________ Zip__________
Home Address (Mailing): Address 1________________________________________________
Address 2________________________________________________
Address 3________________________________________________
City ______________________ State ____________ Zip__________
Personal Email: ___________________________________________________________________
Home Telephone: ___________________________
Signature: __________________________________________ Date:_____________________________
IN THE MATTER OF:
____________________________________
(Registrant’s Legal Name)
VI Bar Number: ______________