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2. Member Profile Survey
4. Name*
6. Title and Municipality*
8. Home Address*
10. City*
11. State*
12. Zip*
14. Home Phone*
15. Cell Phone*
17. Email Address*
19. Former Public Offices Held
    Former Public Offices held
21. Current Profession & Place of Employment
    Current Profession & Place of Employment
23. Areas of Interest or Expertise (Check all that apply)

    1. Environmental (Critical Areas/Smart Growth/Land Use)
    2. Community Development/Parks & Recreation
    3. Planning & Zoning/Growth & Development
    4. Public Safety (Police, Fire, Rescue)
    5. Public Works (Water & Sewer/Roads)
    6. Finance/Insurance/Pensions
24. MML Committee

    1. I may be interested in serving on a MML committee in the future
26. Thank you for assisting the Maryland Municipal League
28. Please return this form to:
    mml@mdmunicipal.org
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field