Utah State Bar Member Services

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The following information is required

You must provide a street address for your business and a street address for your residence.
If your residence is your place of business, it is public information.
Fields that have a * are required for the form to be processed.

Bar Member Information (Required)
*Name
*Bar Number

EFFECTIVE DATE OF CHANGE (Required)
Effective DATE* of Change: MM / DD / YYYY	- -
NOTE: LEAVING THE DATE INFORMATION BLANK WILL RESULT IN MAKING THE EFFECTIVE DATE THE DATE THE FORM INFORMATION IS RECEIVED

1. BUSINESS INFORMATION - Public Information

Business Name
Street Address Line 1
Suite / Floor
Street Address Line 2
City, State, Zip	, ,
Phone
Fax
EMail Address	Public Private

2. BUSINESS P.O. BOX - Public Information

P.O. Box Number
City, State, Zip	, ,

3. RESIDENCE ADDRESS - Private Information (For Internal Bar Use Only)

Street Address Line 1
Apt.
Street Address Line 2
City, State, Zip	, ,
Phone
Fax
Email Address (optional)

Preferred Mailing Address (CHECK ONE)
Business PO Box Residence
Preferred E-Mail Address (CHECK ONE)
Business Residence
I Elect to not receive mailings from parties not affiliated with the Utah State Bar

NOTE: YOUR PREFERRED MAILING ADDRESS WILL BE USED FOR ALL BAR MAILINGS. YOUR BUSINESS ADDRESS OR P.O. BOX WILL BE PROVIDED TO THE UTAH STATE COURTS FOR MAILING OF PLEADINGS AND OTHER OFFICIAL DOCUMENTS OR COMMUNICATIONS. *YOUR RESIDENCE ADDRESS WILL BE PROVIDED TO THE UTAH STATE COURTS IF YOU HAVE PROVIDED NO OTHER ADDRESS

	By submitting this data I certify that I have read the above and the information being provided is current and correct.

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