Expert Bank Application

Please fill in the following information. This form will be used to assist public defenders and private attorneys representing indigent people accused of crimes. WDA Members will have access to this information when seeking an expert witness through WDA’s website, www.defensenet.org.

Contact Information

Name*

First Last

Profession/Type of Expert*

Title

Agency / Company (as used for tax purposes)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email*

Website

Expert Services

Services Provided

Please choose from the following.

Willing to testify?*

Yes
No

Willing to reduce fees for indigent defense cases?*

Yes
No

Willing to travel anywhere in Washington?*

Yes
No

If not, please list your preferred counties of travel.

Statement and CV

Please upload your CV.*

Drop files here or

Max. file size: 256 MB.

Please attach a copy of your most recent and/or most prominent publication.

Drop files here or

Max. file size: 256 MB.

Reference 1 Name

First Last

Reference 1 Title and Organization

Reference 1 Phone Number

Reference 1 Email

Reference 2 Name

First Last

Reference 2 Title and Organization

Reference 2 Phone Number

Reference 2 Email

Reference 3 Name

First Last

Reference 3 Title and Organization

Reference 3 Phone Number

Reference 3 Email

Brief Statement to Prospective Clients Regarding Services

Name

This field is for validation purposes and should be left unchanged.

Expert Bank Applicat...