Name: ________________________________________

Address: ________________________________________

      ________________________________________

E-mail Address: ___________________________________

Phone H: _________________ W: __________________

Fax: _________________

Preferred Method of Communication: __________________

Best Time To Reach: _____________________________

Bar Admissions: ___________________________________

Areas of Legal Expertise (circle all that apply):

Contracts (Drafting, negotiation litigation)

Corporate     Copyright     Employment     Insurance

Intellectual Property     Licensing     Agreements     Litigation     Torts     ADA

Other: _____________________________________________

_____________________________________________

Type of Legal Practice: _____________________________

Return Survey by mail to:

Jeanne Crouse, Esq.

600 Marcia Lane

Rockville, MD 20851

Or fax to: 301-762-7458

Or e-mail to: legalcounsel@usms.org