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Nonprofit Membership Registration Form

Instructions: Please fill in the form below. Once you are finished click the "Pay Now" button and you will routed to a second "Nonprofit Membership Registration Page" where you will select your budget size and corresponding dues amount, then be routed to PayPal to make your payment.

*Indicates required field

*Membership Level Select dues level based on your budget size. The drop-down box displays as "Budget Range -- Dues Amount"

*Name of Nonprofit:
*Contact Person:
*Contact Email:
Organizational Website:
Organizational Email:
*Address:
*City:
*State
*Zip:
*Telephone:
Fax:
*Federal Employer ID Number:
Chief Professional Officer and Title:
Chief Professional Officer Email:
Others in Organization that Should Receive Information from Maryland Nonprofits (Please List Name, Title and Email Address):
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