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Membership Application**
UNITED SENIORS OF MARYLAND
Dues are due by May 31. In accordance with Article 2, Section 2:(a):
“Dues in arrears more than 60 days (i.e. after July 31) will void voting privileges”
Dues Structure (Circle One)
$100 for organizations with 500 or more members
$50 for organizations with less than 500 members
$10 for individual members
Name of Organization_____________________________________________________________
President _______________________________________________________________________
Address
_________________________________________________________________________________
Phone ______________________Fax_____________________E-Mail_______________________________
For the purpose of casting the organization’s vote at meetings, a delegate and an alternate who will vote
in the absence of the delegate should be designated to United Seniors of Maryland.
Name of Delegate
________________________________________________________________________
Address of Delegate _______________________________________________________________________
Phone
_____________________Fax_____________________E-Mail________________________________
Name of Alternate
_______________________________________________________________________
Address
of Alternate
______________________________________________________________________
Phone _____________________Fax_____________________E-Mail________________________________
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Individual Membership Application
Individual members will receive the Board minutes and special notices, can participate in discussion at all
meetings, but do not have a vote.
Name of Individual Member ________________________________________________________________
Address of Individual Member ______________________________________________________________
Phone _____________________Fax_____________________E-Mail_________________________________
Please make checks payable to United Seniors of Maryland. Mail payment with this form to:
United Seniors of Maryland
c/o Chuck Thomas
6153 Forty Winks Way
Columbia, MD 21045
**You should be able to print this page directly off the internet.
