Local Professionalism Panel Referral Form

Important: Upon submission of the electronic Referral form below, the Referring Party must print and sign the Referral form and mail the original Referral to the Panel. If the signed Referral is not received following the electronic submission, the Panel will not accept the Referral. Signature photocopies will not be accepted.
Part One: Referring Party Information
You are a:
Does this referral pertain to a matter currently in litigation?
Part Two: Respondent Attorney Information
Part Three: Facts/Allegations
Nature of Incident:
(Refer to Exhibit A)
Part Four: Witnesses