For Attorneys

2011-2012 Pro Bono Program *

I would like to contribute $
to the Legal Aid Society's Pro Bono Program.

You may make a tax deductible contribution of $350.00 or more to the Legal Aid Society. We are asking our supporters who choose this option to make an additional $50 donation, for a total of $400 this year, to reflect the increased cost of serving pro bono clients since the Florida Supreme Court set the $350 level ten years ago.

and/or

I agree to participate in the Pro Bono Program
(You will be taken to another portion of this form after completing the information on this page).

All Attorneys Please Complete The Following

Name
Firm
Address

City
State
Zip
Telephone
Fax
Florida Bar Number
Member of Federal Bar	Yes No
Email Address
If making a donation, please complete the following:
Name on Credit Card
Credit Card Type
Credit Card Number
Expiration Date
Card Verification Number
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Thank You For Your Participation In The Pro Bono Program!

* This contribution should be reported on your August 1, 2012 Florida Bar Dues Statement

THE LEGAL AID SOCIETY OF PALM BEACH COUNTY, INC. IS A PRIVATE 501(C)(3) NOT FOR PROFIT, TAX EXEMPT ORGANIZATION. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION OF THE LEGAL AID SOCIETY (CH187) MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL FREE 1-800-435-7352 WITHIN THE STATE OF FLORIDA. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE. FLORIDA DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES REGISTRATION #SC-00187. LEGAL AID RECEIVES 100% OF EACH CONTRIBUTION WITH 0% GIVEN TO A PROFESSIONAL SOLICITOR.