APRA-Maryland Chapter

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
201 N. Charles St., Ste 1400, Baltimore, MD 21201
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

How did you hear about us?



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.

Return to APRA-MD Home Page

Top of Page