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Associate Membership Registration Form

*Indicates required field

*Name of Associate:
*Address:
*City:
*State
*Zip:
*Telephone:
*Fax:
*Contact Person:
*Individual Email:
Others in Organization that Should Receive Information from Maryland Nonprofits (Please List Name, Title and Email Address):
*Annual Membership Dues
Steward Membership enables individuals, small business, corporations and government agencies that support and serve the nonprofit sector to provide funding over and above regular annual dues. This membership gift will be leveraged by Maryland Nonprofits to benefit the entire sector of nonprofits in Maryland. Simply pay your dues in increments equal to one, two or three times your annual dues based on the schedule of associate members dues. (For example, a one times Steward Membership payment for an individual would pledge them to pay $300 annually instead of the regular payment of $150). Yes, please sign me up to become a Steward Member. I am willing to make a contribution of of my annual dues.

Do you wish to be listed in our Consultant Databank?
To be completed by future nonprofits (*includes organizing committees, boards, and other groups whose organization has not yet received a nonprofit determination letter from the IRS) only:
Incorporated?	If yes, year incorporated
Board of Directors of more than three unrelated individuals?
Form 1023 filed?	If yes, month and year

Disclosure Statement: The Maryland Association of Nonprofit Organizations is a charitable and educational organization designated as tax-exempt under Internal Revenue Code section 501(c)(3). A copy of our financial statement is available upon request by contacting Maryland Nonprofits, 190 W. Ostend Street, Baltimore, MD 21230. Documents and information submitted under the State of Maryland Charitable Solicitations Act are available from the Office of the Secretary of State of Maryland, Annapolis, MD 21401 for the cost of copying and postage.