The Maine State Society of Washington, DC and The Maine State Society of Washington, DC Foundation

THE MAINE STATE SOCIETY OF WASHINGTON. D. C. MEMBERSHIP APPLICATION
Information is needed to determine eligibility and to create our membership directory.
All information will be kept confidential.
(Please print this page and mail completed form to the address at the bottom.)

NAME:
MAILING ADDRESS:
(lnd.9-digit ZlP code):

Email address:
Home Phone:

EMPLOYMENT (Agency, company, orgn., etc.):
Work Phone:

MAINE HOME TOWN:
COUNTY:
COLLEGE:

For family memberships please complete the following information as appropriate:
NAME OF SPOUSE:
(incl. maiden name if appropriate)

EMPLOYMENT (Agency, (company,orgn.,etc.):
Work Phone:

HOME TOWN:
COUNTY:
COLLEGE:

MINOR CHILDREN:
(Names/ages)

How did you learn about the Society?

Mail completed application with dues (check or M/O payable to MAINE STATE SOCIETY) to:
Membership Director
Maine State Society of Washington, DC
3434 Upside Court
Falls Church, VA 22042-4019
(703) 237-1031

© Copyright 2002. Maine State Society of Washington, DC. All rights reserved.