Application – Join Now!

Contact Information

Name (First Last)*

Home Address

City State Zip Code

Home Telephone

Home E-mail

Employment Information

Employer*

Type of Business / Industry

Title*

Business Address*

City* State* Zip Code*

Business Telephone*

Business FAX*

Business E-mail*

Website

Miscellaneous

Mailing Address to Use* ---Business AddressHome Address

E-mail Address to Use* ---Business E-mailHome E-mail

How did you find out about Baltimore PR Council?*

Referring Member, if applicable

Payment Information

Membership Level* ---Regular member: $75 annuallyStudent member: $35 annuallyRetired: $35 annuallySubsequent corporate member: $60 annually

Payment Method* ---CheckCredit Card

Payments by check (made payable to Baltimore Public Relations Council) must be mailed with a copy of this application to: Baltimore Public Relations Council, 2331 Emory Rd., Reisterstown, MD 21136

Credit Card Payment Information

Name as it Appears on Credit Card (First MI Last)

Billing Address ---Same as Home AddressSame as Business Address

Type of Credit Card ---DiscoverMastercardVisa

Credit Card Number

Expiration Date (Month/Year) /

Verification Code (3 digits on back of card)

*required

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