Authorization And Waiver

Petitioning Attorney, if you are a member of the Illinois Supreme Court, you must submit this Authorization and Waiver form to the Illinois Attorney Registration and Disciplinary Commission located at One Prudential Plaza, Suites 1100 and 1500, 130 East Randolph Drive, Chicago,Illinois 60601, telephone (312) 565-2600. AUTHORIZATION AND WAIVER I hereby authorize the Attorney Registration and Disciplinary Commission and its Administrator to disclose to the United States District Court for theNorthern District of Illinois and any and all information related to pendingdisciplinary investigations or proceedings pertaining to me. I expresslywaive whatever rights I may have to the confidentiality of the above information under Supreme Court Rule 766 in connection with disclosures made pursuant to this authorization. ____________________ ___________________(Print or Type Name) Signature____________________ ___________Registration Number Date