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* Branch:
* Military Status:
* Highest Rank or Grade:
* Years Served:
* Branch MOS:
* Combat Experience:
* Number of Tours:
* Closest military base:
* Highest Security Clearance:
* How did you hear about us:

* First Name:
Required: Please Enter First Name
Required: Enter Only Alphabetic characters in First Name
Required: First Name Minimum length = 2, Maximum length = 50
* Last Name:
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Required: Enter Only Alphabetic characters Last Name
Required: Last Name minimum Length = 10, Maximum Length = 50
  Middle Initial:
Required: Enter Only Alphabetic character Middle Initial
* Drivers License or State ID #:

* Verify Drivers License or State ID #:

stateidnumerror Required: Please enter valid state issued identification.
Required: Please enter proper identification, drivers license or state issued ID number. Please use only alphanumeric characters. Hyphens(-) would not be accepted.
Your ID already exists in the database please email arenfroe@trialpractice.com or Call 1-800-544-5798 to update your file. Thank you.
Required: Please enter vaild state issued identification twice for verification
Required: Please check your entries they do not match.
* Home Phone Number: (ex: 555-678-9012)
Required: Enter only Numbers in Home Phone Number
Required: Home Phone Number must include Area Code
  Cell Phone Number: (ex: 555-678-9012)
Required: Enter only Numbers in Cell Phone Number
Required: Cell Phone Number must include Area Code
Required: Enter any Home/ Work/ Cell Phone Number for Contact
  Work Phone Number: (ex: 555-678-9012)
  Extension:
Required: Enter only Numbers in Work Phone Number
Required: Work Phone Number must include Area Code
* Email Address:
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* Verify Email Address:
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Required: Please Verify Email Address
* ZIP Code:

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Required: Enter only Numbers in ZIP Code
Required: ZIP Code Minimum Length 5 Digits
Required: Please Enter Valid ZIP Code
  City:
  State:
  County:
  Street Address:
Required: Enter only AlphaNumeric characters in Address
Required: Address Minimum length = 10, Maximum length = 100
  Street Address 2:
* Race:
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* Gender:
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* Date of Birth:    
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Required: Please select Birth Day
Required: Please select Birth Year

  Are you registered to vote in your county?  

  Are you a U.S. Citizen?  

  Have you been convicted of a Felony?  

  Are you currently a student?  

  Occupation:


  Job Title:
  Education Completed:
  Marital Status:
  Number of Children:
  Political Affiliation:
  Religious Preference:
  Religious Service Attendance:

  Annual Household Income:

  Do you favor the death penalty:

  Are you physically handicap:

  Details of the automobile you drive:

          Year:
           Make:
            Model:

Have you every served as a mock juror before?

If yes, when, where and with what company?

Required: Enter only AlphaNumeric characters in Make of Automotive
Required: Automobile Make Minimum length = 3, Maximum length = 50
Required: Enter only Alphanumeric characters in Model of Automotive
Required: Automobile Model Minimum length = 3, Maximum length = 50
  Which magazines, newspapers, or   websites do you read regularly?


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