Lifetime Achievement Award

Please complete the form below to process your Premier Lawyers of America Lifetime Achievement Award.

Username*

Password*

Retype Password *

First Name *

Middle Name or Initial

Last Name *

Law firm or Organization

Address *

Address 2

City *

Country *

State *

Zip Code *

Phone

Fax

Email *

Select up to 5 areas of practice (Press "ctrl+click" to select multiple areas)

Website (make sure to enter http://www. or https://www.)

Enter your name exactly as you would like it to appear on your member certificate, plaque and crystal statue *

Practice area to appear on member certificate *

Practice area to appear on plaque *

Practice area to appear on crystal statue *

Select up to 4 areas of practice for "Top 1%" or specialty logo badges (such as "$10 Million+ Recovered") (Press "ctrl+click" to select multiple areas)

Would you like to be considered for "Top 40 under 40" recognition?

Yes

Are you interested in attending the Premier Lawyers of America Gala & Retreat?

Yes

Payment Information

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