Membership Form

If you would like to become a new member of APRA-MD, or renew your membership, please fill out the form below.
You can print it out and mail it with your dues (preferred method), or click "Send" to e-mail the form to us and mail the check separately.

Dues are $25 annually (July 1 to June 30) and checks should be made out to: APRA-MD.
Please mail dues to APRA-MD, c/o Caitlin Rettaliata, Johns Hopkins Development Research
San Martin Center, 3400 N. Charles St., Baltimore, MD 21218
Membership will contact you when we have received both your form and dues.

Name:
Nickname:
Title:
Organization:
Address1:
Address2:
City:
State:
ZIP Code:
E-mail:
Telephone Number:
Fax:

Check Number:
Total Amount:

Please choose one:	INDIVIDUAL INSTITUTIONAL
Individual Membership is assigned to the person who joins APRA-MD, and stays with that person even if s/he moves to a different organization.
Institutional Membership belongs to the organization and is assigned to ONE person from that organization. If the person leaves the organization, the membership may be re-assigned to another person at that organization. Please notify APRA-MD promptly if the Institutional Membership is being re-assigned.
Please choose one:	NEW MEMBER RENEWING MEMBER

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This form uses Microsoft Outlook Express mail. If you should have problems sending information with this form, please print out the completed form and snail-mail it or copy and paste the information and send it through your regular email. Thank you.

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