I, the undersigned hereby apply for membership in the The SHOMRIM
SOCIETY OF MARYLAND.

Attached herewith $_____________________ to cover initiation fee.

Name _______________________  Spouse’s name ________________    Business Name: _____________________________________________
Address: ________________________________________________
City, State, Zipcode:__________                                               _
Phone: __________________________________________________
Email address:  ___________________________________________
Date of Birth:  __________________________  Age ________
Occupation _______________________________________________
Employed by:  _____________________________________________
Business Address: _________________________________________
City, State, Zipcode: _____________
Business Phone:  __________________________________________
Applicant’s Signature _______________________________________
Proposed by: ______________________________________________

 Yearly dues must be paid in full at the time of application

Dues

Active Member:           $10.00 ______
Associate Member:      $20.00 ______
Retired Member:          $5.00  ______

*Business Membership: $30.00 ______

*Includes link to your business added to our website

Make your check payable to The Shomrim Society of Maryland Inc. and mail with your application to:

The Shomrim Society of Maryland Inc.
P.O. Box 65
Boring Maryland 21020