Personal Information First Name * Middle Name Last Name * Suffix - None -Jr.Sr.Dr.MD.II.III.IV.PHD. Bar ID and Admission Date Date Admitted to the TN State Bar, if appl TN Bar ID No, if appl Admission InformationAttorneys seeking to file documents electronically must be admitted to practice in the United States District Court for the Middle District of Tennessee. Please complete which applies. Date admitted to practice in the USDC/MDTN If admitted pro hac vice: Date motion for pro hac vice was granted Case number State Bar ID No If pro hac vice, State Bar ID No is MANDATORY. State Admitted - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming State or territory of admission Other Information You are in good standing * - Select -N/AYesNo If attorney representing U. S. Government * - Select -N/AYesNo Office Address Firm Name Address Line 1 * Address Line 2 Address Line 3 City State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming State or territory name Zip Contact Information Phone number - voice Fax number Email address Electronic SignatureBy submitting this form, the undersigned agrees to abide by all Court rules, orders, policies and procedures governing the use of the electronic filing system. The undersigned also consents to receiving notice of filings pursuant to Fed.R.Civ.P.5(b) and 77(d) and Fed.R.Crim.P.49(b)-(d) via the Courts electronic filing system. The undersigned further certifies that they have read and understood the Court's Administrative Practices and Procedures for Electronic Case Filing, which are available through the CM/ECF link at the Court's website at: http://www.tnmd.uscourts.gov/. Signature of Registrant * Submission Date Training All attorneys admitted locally to the Court pursuant to Local Rule 83.01(c) after the effective date of the Administrative Practices and Procedures for Electronic Case Filing shall participate in Court approved Electronic Case Filing training within sixty (60) days of admission to the Court. This requirement does not apply to attorneys admitted pro hac vice. The training requirement will be waived if counsel has attended training in another District or Bankruptcy Court evidenced by a certificate of attendance or letter from that Court, which can be faxed to (615) 736-2229. Training class schedules are available at the Court's website at http://www.tnmd.uscourts.gov/. Submit this form by clicking the "SUBMIT" button below and e-mailing it to the Court. Alternatively, this form can be printed and sent to ATTN: CM/ECF Registration Form, U.S. District Court, 801 Broadway, Room 800, Nashville TN 37203. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 1 + 3 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
