CLEA Lawyer Referral Panel

Registration Form

Thank you for your interest in joining CLEA's lawyer referral panel! Please fill out this brief registration form, and we will contact you shortly.

Question Title

* 1. Please enter your contact information:

Name *

Firm Name *

Address *

Address 2

City/Town *

Postal Code *

Email Address *

Phone Number *

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* 2. In what year were you called to the Bar in Manitoba?

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* 3. In which languages do/can you practice?

#1:

#2:

#3:

#4:

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* 4. Are you comfortable communicating in American Sign Language (ASL)?

Yes

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* 5. Please select your 3 main areas of practice:

Administrative

Agriculture

Aviation

Bankruptcy / Creditors' Rights

Child Protection

Civil Court Actions

Commercial / Corporate

Condominium

Consumer Protection

Corporate / Non-Profit

Criminal

Employment Insurance

Employment / Wrongful Dismissal

Entertainment

Expropriation

Family

Franchise

Human Rights

Immigration

Indigenous Law

Insurance

Intellectual Property

Labour

Landlord & Tenant

Medical Malpractice

Military

MPI

Municipal

Real Estate

Securities

Sexual Harassment

Taxation

Welfare

Wills / Estates / Trusts

Workers' Compensation

Youth Court

Other (please specify)

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* 6. Of your 3 main areas of practice, please rank them in order of your experience in each area.

#1:

#2:

#3:

In the last 5 years, how many cases have you worked on in each of your main 3 areas?

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* 7. Area #1:

30+

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 8. Area #2:

30+

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 9. Area #3:

30+

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. Please provide information about your experience in your main areas of practice:

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* 11. Please let us know about any unique case experience or specific areas of practice you would like us to know about.

Ex: Charter experience, precedent-setting/changing cases, etc.

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* 12. Some clients requesting our services are "shut in" due to ill health, disability, and/or old age, and cannot attend in person at a lawyer's office.

Please check one of the following:

I will accept referral clients who are "shut in" and agree to attend, if necessary, at their residence or hospital.

I will not accept referral clients who are "shut in."

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* 13. Some clients requesting our services qualify for Legal Aid, but some do not.

Please check at least one of the following:

I am on Legal Aid's panel list, and agree to accept referral clients who may ultimately qualify for Legal Aid.

I am not prepared to accept referral clients who qualify for Legal Aid.

I am prepared to take Legal Aid cases on a reduced tariff.

I am not prepared to take Legal Aid cases on a reduced tariff.

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* 14. Some clients requesting our services request that their case be handled on a contingency fee basis.

Please check one of the following:

I am prepared to take cases on a contingency fee basis.

I am not prepared to take cases on a contingency fee basis.

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* 15. By registering for the Lawyer Referral Panel, you agree to the following statements.

Please confirm your agreement by checking next to each statement:

I agree to participate in the Lawyer Referral Service. Provided there is no conflict of interest, and it is not otherwise improper, I will personally provide an initial, half-hour consultation to anyone referred to me who requires legal assistance in the branches of law I have indicated on the preceding page.

In the event of a conflict of interest, or other reason which would prevent me from personally providing the initial half-hour consultation, I agree to refer the client back to the Lawyer Referral Service for a substitute referral.

I agree to provide the initial half-hour consultation for no fee. I understand that if additional services are required, the client is free to seek my assistance on my usual basis of legal charges.

I agree to return Lawyer Referral evaluation forms promptly.

I certify that I am not required to pay a surcharge on my insurance premium of 100% or more (representing 3 paid claims in the previous 5 years).

I agree to notify the Lawyer Referral Service immediately should I become ineligible or unable to accept referrals.

I undertake to advise the Lawyer Referral Service and not to take referrals while I am under criminal investigation, or investigation or suspension by the Law Society of Manitoba or any other law society.

I agree to notify the Lawyer Referral Service immediately of any change of address, choice of category, or other information contained in this application form.

I understand that my name may be removed from the Lawyer Referral Service if complaints received are validated by the Lawyer Referral Service.

I certify that all information contained in this application form is correct.

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* 16. Please "sign" your application form by typing your name below:

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* 17. Please enter today's date:

Date

Thank you for completing our registration form! We will contact you shortly.

CLEA Lawyer Referral Panel

Registration Form

Question Title

* 1. Please enter your contact information:

Question Title

* 2. In what year were you called to the Bar in Manitoba?

Question Title

* 3. In which languages do/can you practice?

Question Title

* 4. Are you comfortable communicating in American Sign Language (ASL)?

Question Title

* 5. Please select your 3 main areas of practice:

Question Title

* 6. Of your 3 main areas of practice, please rank them in order of your experience in each area.

Question Title

* 7. Area #1:

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* 8. Area #2:

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* 9. Area #3:

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* 10. Please provide information about your experience in your main areas of practice:

Question Title

* 11. Please let us know about any unique case experience or specific areas of practice you would like us to know about. Ex: Charter experience, precedent-setting/changing cases, etc.

Question Title

* 12. Some clients requesting our services are "shut in" due to ill health, disability, and/or old age, and cannot attend in person at a lawyer's office. Please check one of the following:

Question Title

* 13. Some clients requesting our services qualify for Legal Aid, but some do not. Please check at least one of the following:

Question Title

* 14. Some clients requesting our services request that their case be handled on a contingency fee basis. Please check one of the following:

Question Title

* 15. By registering for the Lawyer Referral Panel, you agree to the following statements. Please confirm your agreement by checking next to each statement:

Question Title

* 16. Please "sign" your application form by typing your name below:

Question Title

* 17. Please enter today's date:

* 11. Please let us know about any unique case experience or specific areas of practice you would like us to know about.

Ex: Charter experience, precedent-setting/changing cases, etc.

* 12. Some clients requesting our services are "shut in" due to ill health, disability, and/or old age, and cannot attend in person at a lawyer's office.

Please check one of the following:

* 13. Some clients requesting our services qualify for Legal Aid, but some do not.

Please check at least one of the following:

* 14. Some clients requesting our services request that their case be handled on a contingency fee basis.

Please check one of the following:

* 15. By registering for the Lawyer Referral Panel, you agree to the following statements.

Please confirm your agreement by checking next to each statement: