Malpractice Insurance Coverage MARYLAND CENTER FOR LEGAL ASSISTANCE PRO BONO PROGRAM Information for Malpractice Insurance Coverage Attorney Information: By submitting this information the undersigned counsel represents that they are currently admitted to practice law and in good standing in the State of Maryland. By signing, the undersigned agrees that they have no pending attorney grievance actions against them. First Name * Last Name * Your Email * Number of years as a practicing attorney * Primary practice areas include: Family LawLandlord TenantDebtor/CreditorSmall and Large ClaimsForeclosureReplevin/DetinueGuardianshipExpungementPeace and Protective OrdersAdministrative Appeals Are you admitted to practice law in other states? *—Please choose an option—YesNo If Yes: Are you in good standing? *—Please choose an option—YesNo Do you have pending attorney grievances against you? *—Please choose an option—YesNo Are you in compliance with all state filing requirements, including registration under the Client Protection Fund of the Bar of Maryland? *—Please choose an option—YesNo I consent to signing this form electronically.