| 1. Today's Date | |
| 2. First Name | |
| 3. Last Name | |
| 4. Email Address | |
5. Interests
ctrl-click to select multiple | |
| 6. Age | |
| 7. Gender | |
| 8. Education | |
| 9. Address | |
| 10. City | |
| 11. State | |
| 12. Zip | |
| 13. Country | |
| 14. Home Phone | |
| 15. Office Phone | |
| 16. Occupation | |
| 17. Company/College/University/Firm Name | |
| 18. Organization Type | |
| 19. Internet Experience | |
| 20. If you are a member of the legal profession, what is your area of expertise | |
21. May we contact you privately regarding the potential for partnering with your organization, school, or firm
tick box if "yes" | |
22. Legal Education
ctrl-click to select multiple | |
| Other Legal Education | |
23. Do you have International Work Experience
tick box if "yes" | |
24. Please select all in which you are fluent
ctrl-click to select multiple | |
25. Please select any country other than your current resident address where you have lived or worked for any meaningful length of time
ctrl-click to select multiple | |
26. If you are interested in volunteering time to LWOB, please select a task that interests you
ctrl-click to select multiple | |
| 27. Select the item that best describes your internet access and use | |
28. Do you have law books you or your firm are discarding which you are willing to pay to ship to Africa
tick box if "yes" | |
29. If you are interested in becoming a financial supporter to LWOB, please select the statement that applies to you
ctrl-click to select multiple | |
30. If you are interested in an ongoing or planned project at LWOB, select all that apply
ctrl-click to select multiple | |
| 31. Comments: If you have other relevant experience or qualifications, please list them here. | |
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