Yes! I would like to join ACC. - Association of Corporate Counsel

By in-house counsel, for in-house counsel.®
Yes! I would like to join ACC.
Submission of this application constitutes agreement to abide by ACC Bylaws (www.acc.com/bylaws.pdf). Membership in ACC is open to individuals
who are engaged in the active practice of law on behalf of organizations in the private sector (www.acc.com/eligibility). This precludes individuals who
hold themselves out to the public for the practice of law and whose primary responsibility is to sell or provide service to individuals or organizations
who are not their employer. ONLY an ACC Member may use the login information provided. This application is for membership in both ACC and
the local ACC chapter. Applicants admitted as ACC members automatically become a member of their local ACC chapter. See ACC privacy policy at
www.acc.com/aboutacc/privacypolicy.cfm. Occasionally, ACC will seek your consent to share some of your data with vendors/sponsors.
To contact ACC, write, call, or email:
Association of Corporate Counsel (ACC)
Membership Department
1025 Connecticut Avenue, NW, Suite 200
Washington, DC 20036-5425 USA
tel +1 202.293.4103 x 360; fax +1 202.293.2003
[email protected]
www.acc.com
By entering my data in this application form, I hereby unambiguously consent to the processing of such data by ACC in the United States, which will
be limited to its storage in a database aimed at centralizing contact details of the association’s members and enabling ACC and its fellow members
to reach out to me for future initiatives in a timely and organized manner. Should I want to withdraw my consent, I will need to send an email to
[email protected].
Signature ________________________________________________________________________________________
(Check one) ❑ Mr. ❑ Ms.
First Name
CODE: website
Middle Initial
Last Name
Title
Communications/Mailings
❑A
CC occasionally makes its member’s name, title, organization
and postal address available to vendors who provide products and
services to the association community. Please opt-in to be included
in mailings of this type. You can withdraw this consent at any time
by sending an email to this effect at [email protected].
Organization name
How did you learn about ACC?
Mailing address
Address continued
City
❑ Attended local Chapter event
❑ Magazine or
newspaper story
❑ ACC homepage or
other internet source
❑ Mail from ACC
❑ Social Media
❑ In law school
❑ Other
❑ From a colleague. Name
State/Province
Zip/Postal Code
Country
+
Country Code
❑ Attended Annual Conference
Area Code
Telephone Number
Demographics (optional)
This information is for the purpose of enhancing ACC efforts to
reflect diversity within its activities. It will not be provided to any
external entity except in summary form.
❑ Male
Email
❑ Female
Date of birth (DD/MM/YY) ________________________________
Nationality ______________________________________________
Secondary Email
Deductibility
For US citizens only: ACC dues are not deductible as a charitable
Country(ies) in which admitted
Law school
Year graduated
Briefly describe your primary duties:
Parent company’s name ___________________________________________________________
❑ Please send me information on pro bono activities.
Committees
Please select the Committees you wish to join (free to members; unlimited selection).
contribution for US federal income tax purposes, but may be
deductible as a business expense. For non-US citizens only:
Please check your local tax laws regarding deductibility.
Membership/Dues
Membership is for one year from the date dues are received. Annual
dues are US$335 per person, which includes chapter and committee
memberships. Chapter assignments are automatically made based on
location. An ACC Docket subscription (US$50) is an automatic and
non-severable benefit of membership.
Please indicate payment method for US$335.
❑ Compliance & Ethics
❑ International Legal Affairs
❑ Corporate & Securities Law
❑ Intellectual Property
❑ Employment & Labor
❑ Law Department Management
❑ Energy
❑ Litigation
❑ Transfer to: PNC Bank
800 17th Street NW, 3rd Floor
Washington, DC 20006 USA
SWIFT Code: PNCCUS33 | Routing/ABA Number: 031000053
Account Title: Association of Corporate Counsel
Account Number: 5303564367
❑ Environmental & Sustainability
❑ New to In-house
Charge my: ❑ VISA ❑ Mastercard ❑ AMEX ❑ Discover
❑ Financial Services
❑ Nonprofit Organizations
❑ Health Law
❑ Real Estate Law
❑ IT, Privacy & eCommerce
❑ Small Law Departments
❑ Insurance Staff Counsel
❑ Sports & Entertainment
Account number
Exp. Date (MMYY)
Printed name
Signature
07/2014
You will receive documents from ACC in English.
By in-house counsel, for in-house counsel.®
Targeted Practice Information
Please complete the following questionnaire so that we can send you targeted practice information relevant to your career stage.
NUMBER OF YEARS WORKING AS IN-HOUSE COUNSEL
❑ 1–2 years ❑ 3–5 years ❑ 6–10 years ❑ 11–15 years ❑ 16–20 years ❑ 21 + years
TITLE WHICH BEST DESCRIBES YOUR POSITION
❑ Chief Legal Officer/General Counsel
❑ Division Counsel
❑ Deputy General Counsel
❑ Assistant/Associate General Counsel –
Supervisory
❑ Assistant/Associate General Counsel –
Non-supervisory
❑ Managing Lawyer (New)
❑ Managing Lawyer (3+ years)
❑ Senior Lawyer
❑ Staff Lawyer
❑ Other
PRIMARY PRACTICE AREA
❑ Commercial Law
❑ Financial Services
❑ Litigation
❑ Compliance & Ethics
❑ Government
❑ Media/Publishing
❑ Corporate, Securities & Governance
❑ Insurance
❑ Real Estate
❑ Employment & Labor
❑ Intellectual Property
❑ Technology
❑ Energy/Public Utility
❑ International
❑ Environmental Law
❑ Law Department Administration
INDUSTRY
❑ Accommodation and Food Services
❑ Health Care & Social Assistance
❑ Public Administration
❑ Administrative and Support & Waste
Management and Remediation Services
❑ Information Technology
❑ Real Estate Rental and Leasing
❑ Management of Companies &
Enterprises
❑ Retail Trade
❑ Manufacturing
❑ Transportation and Warehousing
❑ Agriculture, Forestry, Fishing
& Hunting
❑ Arts, Entertainment & Recreation
❑ Construction
❑ Mining
❑ Educational Services
❑ Non-Profit, Industry Group or
Trade Association
❑ Energy, Oil & Gas
❑ Pharmaceuticals
❑ Finance, Banking or Insurance
❑ Professional, Scientific &
Technical Services
❑ Telecommunications
❑ University/Academia
❑ Utilities
❑ Wholesale Trade
❑ Other
NUMBER OF LAWYERS IN YOUR LEGAL DEPARTMENT (including yourself & all counsel at all locations)
❑ 1 ❑ 2–5 ❑ 6–10 ❑ 11–20 ❑ 21–50 ❑ 51+
MY COMPANY IS
❑ Public ❑ Private ❑ Non-profit
MY COMPANY OPERATES IN
❑ Asia Pacific ❑ Canada ❑ Europe ❑ Latin America ❑ Middle East and North Africa ❑ Sub-Saharan Africa ❑ USA

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