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AMERICAN SOCIETY
for PHARMACY LAW
3085 Stevenson Dr., Ste. 200    Springfield, IL 62703    217-529-6948
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Attorney Referral Service Information Form

Fields with " * " are required and must be entered.

* First Name: Middle Initial: * Last Name:
Credentials:
* Firm/Company:
* Address:
* City, State Zip: ,
* Telephone:
217-555-1212
Fax Number:
217-555-1212
* E-mail:
Web Site:
Briefly Describe your
* Area of Expertise
* State List:
Enter 2 Character State Abbreviations separated by Comma's - IL,MO,OH, etc.
Your fee will be $100 for each state in this list.

 
Areas of Practice
 Plaintiff's Counsel
 Pharmacy Board Counsel
 Defense Counsel
 Food & Drug Counsel Issues
 Other Pharmacy

 

Attorney Referral Service Information

*****Please Note*****

  1. By submitting this form, you acknowledge and accept the Attorney Referral Service requirement of a no-charge, initial consultation for those who contact you through the Attorney Referral Service. ASPL acknowledges that after the initial consultation, you will have no restrictions based on the requirements of the ASPL Attorney Referral Service.
  2. Individual Attorneys are responsible for adhering to the rules of Professional Responsibility including any and all advertising requirements.