UNITED STATES DISTRICT COURT
DISTRICT OF OREGON

ivil 15-cv-01857-BR
Lori Wakefield, individually and on behalf of Civil Case No. “Soiree

all others similarly situated, APPLICATION FOR SPECIAL

Plaintiff(s), ADMISSION ~ PRO HAC VICE

v
ViSalus, Inc., a Nevada corporation,

Defendant(s).

Attorney Raley S. Balabanian requests special admission pro hac vice in

the above-captioned case.

Certification of Attorney Seeking Pro Hac Vice Admission: | have read and understand the
requirements of LR 83-3, and certify that the following information is correct:

dg) PERSONAL DATA:
Name; Balabanian Rafey Ss
hast Name} (First Name) (Mh Sufi
Firm or Business Affiliation: Edelson PC
350 North LaSalle Street, Suite 1300

Mailing Address:
City:Chicago State; lllinois Zip: 60654

Phone Number: (312) 589-6370 Fax Number: (612) 589-6378

Business E-mail Address: "alabanian@edelson.com

U.S. District Court-Oregon Application for Special Admission - Pro Hac Vice
Revised March 1, 2014 Page | of 3


(2) BAR ADMISSIONS INFORMATION:

(a) State bar admission(s), date(s) of admission, and bar ID number(s):
Illinois, 11/10/2005, #6285687

(b) Other federal court admission(s), date(s) of admission, and bar 1D number(s):
Northern District of Illinois, 11/10/05, Central District of Hllinais 1/12/06

Seventh Circuit Court of Appeals, 8/15/08, Ninth Circuit Court of Appeals
12/17/10, Northern District of Florida, 5/31/11 District of Colorado 3/16/12

(3) CERTIFICATION OF DISCIPLINARY ACTIONS:
(a) 1 am not now, nor have | ever been subject to any disciplinary action by any

state or federal bar association; or

(b) [1am now or have been subject to disciplinary action from a state or federal bar
association. (See attached letter of explanation.)
(4) CERTIFICATION OF PROFESSIONAL LIABILITY INSURANCE:

I have professional liability insurance, or financial responsibility equivalent to Jiability
insurance, that will apply and remain in force for the duration of the case, including any
appeal proceedings.

(5) REPRESENTATION STATEMENT:

1am representing the following party(s) in this case:
Plaintiff, Lori Wakefield

US. District Court-Oregon Application for Special Admission - Pro Hac Vice
Revised March 1, 2014 Page 2 of 3


(6) CM/ECF REGISTRATION:

Concurrent with approval of this pro hac vice application. | acknowledge that ] will
become a registered user of the Court's Case Management/Electronic Case File system.
(See the Court's website at ord.uscourts.gov), and } consent to electronic service pursuant
to Fed. R. Civ. P 5(b)(2)(E) and the Local Rules of the District of Oregon,

DATED this 9th day of October 2015

(Signature of Pro Hac Counsel}

Rafey S. Balabanian
(iped Name)

CERTIFICATION OF ASSOCIATED LOCAL COUNSEL:

! certify that | am a member in good standing of the bar of this Court, that | have read and understand the
requirements of LR 83-3, and that | will serve as designated local counsel in this particular case.

DATED this 9th day of October , 2015

eee cee el

“(Signature of Local Counsel)

Kocher Scott F
thast Name} (First Name) MD) (Siuffixd

Oregon State Bar Number: #015088

Firm or Business Affiliation: Forum Law Group LLC
Mailing Address; 811 SW Naito Parkway Suite 420

Name:

City; Portland State: Oregon Zip: 97204
Phone Number; (503) 445-2102 Business E-mail Address: SCott@forumlawgroup.com
COURT ACTION

© Application approved subject to payment of fees.
© Application denied.

DATED this day of +

Judge

US, District Court-Oregon Application for Special Admission - Pro Hae Vice
Revised March 1. 2014 Page 3 of 3