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REGISTRATION - Dental /Physician
No Charge Membership

with access to Mediation , Arbitration & Legal Counsel procedures.
( We assist you in evaluating the pros and cons of each )

Please complete the following fields with *

Picture in Profile Page File:

Select a Login Name *:
First Name *:
Last Name *:
Gender *:
Date of Birth:
E-mail *:
Web address/Home Page:

Address *:  
City *:
State *:
Postal Code *:
Profession category*:
Member of Professionial Organization*:
Holds Professionial Insurance YES (and Name)/NO* :
Phone ( only numbers)*:
Describe Your Occupation*:  
Your Computer IP number:
(For security reasons)

e-Court USA will negotiate "lower" premiums with your malpractice insurance provider.
You shall be entitled to display the member vignette on your letter heading and website Legal Services International LLC. Wilmington, Delaware USA
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