National Client Protection Organization                
                                                                                            Incorporated

Organizational Membership Application

                                   Organizational Membership dues for the year May 1, 2005 through April 30, 2006  is $200.00.

                                  Enclose check payable to:                        NCPO, Inc.

                                                          Mail to:                               Timothy O'Sullivan, Treasurer                                                                       
                                                                                     New York Lawyers' Fund  for Client Protection                                                                                                         119 Washington Avenue                                               
                                                                                     Albany, NY  12210

Please provide address or telephone number below:

                                                     Name: _____________________________________

                                                  Address: _____________________________________

                                                                   _____________________________________

                                                       City: ___________ State:___________ Zip:_________

                                                    Phone:(____)____-______ E-Mail: ______@___________