Your annual dues of $20 support the mission and goals of the Homes for Life Coalition. Please mail the completed membership form and your check (payable to HFLC) to Treasurer, Homes for Life Coalition, P.O. Box 1308, Columbia, MD 21044.

Name___________________________________  Title________________________

Organization______________________________ Occupation__________________

Address______________________________________________________________

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Is this a home or work address?____________ Howard County resident? (Y/N)____

Telephone (h)________________(w)________________Fax___________________

Email (h)________________________________(w)__________________________

Please circle which email address(es) you prefer we use.

Committee Interests: (check all that apply)   Membership ______  Fundraising_____

Advocacy_____  Consumer Education_____  Professional Training_____

Please list any of your interests, skills, and links to other organizations that may help HFLC.

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For Office Use Only:

 Membership Dues Paid ____________  Date____________