Nonprofit Membership Registration Form

*Indicates required field

*Name of Nonprofit:
Organizational Website:
Organizational Email:
*Address:
*City:
*State
*Zip:
*Telephone:
Fax:
*Federal Employer ID Number:
Chief Professional Officer and Title:
Chief Professional Officer Email:
Contact Person (If Different):
Contact Email:
Others in Organization that Should Receive Information from Maryland Nonprofits (Please List Name, Title and Email Address):
*Organization Dues
Advanced Membership enables organizations 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 size of your organization's budget. (For example, a one times Advanced Membership payment is equal to paying double your regular annual dues payment). Yes, please sign me up to become an Advanced Member. I am willing to make a contribution of of my annual dues.
Are there other offices or affiliates of your organization within the state of Maryland?	Yes No
If yes, are they a member?	Yes No
Have you taken advantage of Maryland Nonprofits programs and services in the past?	Yes No