Maryland Consumer Rights Coalititon
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Organization Membership Application

 
Please fill out the form below and then click on "submit".  Information in red is required with an asterik is required. You may use the "tab" key to go from one line to the next.
Name of Organization
Contact Person
Address
Address
City
State        Zip
Telephone
Fax
E-mail
 

Dues are Based on Organization's Budget
Budget Dues Amount
$50,000 or less  $    50.00
$51,0000 - $100,000  $  100.00
$101,000 - $300,000  $  200.00
$301,000 - $500,000  $  300.00
Over $500,000  $  500.00
Founding Member        $1,000.00
Note: A request for reduction of the dues amount will be considered by theBoard

             

Your name will not be used in any literature, letters or other documents without your approval.

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11/22/06 12:44 PM