`
`United States District Court
`Western District of Washington
`
`Case Number:
`
`APPLICATION FOR LEAVE TO APPEAR
`PRO HAC VICE
`
`Plaintiff(s)
`
`V.
`
`Defendant(s)
`
`Pursuant to LCR 83.1(d) of the United States District Court for the Western District of Washington,
`
` hereby applies for permission to appear and participate as
`counsel in the above entitled action on behalf of the following party or parties:
`
`The particular need for my appearance and participation is:
`
`I,
`all applicable local rules;
`
` understand that I am charged with knowing and complying with
`
`I have not been disbarred or formally censured by a court of record or by a state bar association; and there are
`not disciplinary proceedings against me.
`
`I declare under penalty of perjury that the foregoing is true and correct.
`
`Date:
`
`Signature of Applicant: s/
`
`Page - 1 of 3
`
`WAWD - Application for Leave to Appear Pro Hac Vice (Revised 11/21/2017)
`
`
`
`Case 2:17-cv-00932-JLR Document 55 Filed 02/08/18 Page 2 of 3
`
`Pro Hac Vice Attorney
`
`Applicant's Name:
`
`Law Firm Name:
`
`Street Address 1:
`
`Address Line 2:
`
`City:
`
` State:
`
` Zip:
`
`Phone Number w/ Area Code
`Primary E-mail Address:
`(Primary E-Mail address must be for the Pro Hac attorney and not any subordinate or staff member)
`
` Bar #
`
` State
`
`Secondary E-mail Address:
`
`STATEMENT OF LOCAL COUNSEL
`
`I am authorized and will be prepared to handle this matter, including trial, in the event the
`applicant
` is unable to be present upon any date
`assigned by the court.
`
`Date:
`
` Signature of Local Counsel: s/
`
`Local Counsel's Name:
`
`Law Firm Name:
`
`Street Address 1:
`
`Address Line 2:
`
`City:
`
` State:
`
` Zip:
`
`Phone Number w/ Area Code
`
` Bar #
`
`Page - 2 of 3
`
`WAWD - Application for Leave to Appear Pro Hac Vice (Revised 11/21/2017)
`
`
`
`Case 2:17-cv-00932-JLR Document 55 Filed 02/08/18 Page 3 of 3
`
`Electronic Case Filing Agreement
`
`
`
`By submitting this form, the undersigned understands and agrees to the following:
`
`1. The CM/ECF system is to be used for filing and reviewing electronic documents, docket sheets, and notices.
`
`2. The password issued to you by the court, combined with your login, serves as your signature under Federal
`Rule of Civil Procedure 11. Therefore, you are responsible for protecting and securing this password
`against unauthorized use.
`
`3.
`
`If you have any reason to suspect that your password has been compromised in any way, you are
`responsible for immediately notifying the court. Members of the court's systems staff will assess the risk
`and advise you accordingly.
`
`4. By signing this Registration Form, you consent to receive notice electronically, and to waive your right to
`receive notice by personal service or first class mail pursuant to Federal Rule of Civil Procedure 5(b)(2)(C),
`except with regard to service of a complaint and summons. This provision does include electronic notice of
`the entry of an order or judgment.
`
`5. You will continue to access court information via the Western District of Washington's internet site or
`through the Public Access to Court Electronic Records (PACER) system. You will continue to need a PACER
`login, in addition to the court-issued password. You can register for PACER at their web site: http://pacer.
`psc.uscourts.gov.
`
`6. By this registration, the undersigned agrees to abide by the rules and regulations in the most recent
`General Order, the Electronic Filing Procedures developed by the Clerk's Office, and any changes or
`additions that may be made to such administrative procedures in the future.
`
`Date Signed
`
`
`
`
` Signature s/
`(Pro Hac Vice applicant name)
`
`Page - 3 of 3
`
`WAWD - Application for Leave to Appear Pro Hac Vice (Revised 11/21/2017)
`
`