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Advocating, collaborating, and educating for people with intellectual and developmental disabilities.

  • Fields marked with * are required.

  • Membership Information

  • Please select the appropriate membership category.


  • DD Budget with Corresponding Dues:

  • If paying by check, please print and fill out this form and mail your dues check to the address below.

  • If paying by credit card, please note, the processing fee for paying by credit card will be added to your dues amount. (3.9% bank administration fee plus .30 cents). Click here to pay by credit card.

Enter Dues Calculation

Please indicate your Prince George’s CountyDD operating budgeted amount for FY24*:

(Provide your best estimate if you are a multicounty provider and don’t have a solid budget number by county.)

Approximate number of Prince George’s County residents to be served as of
July 2023 

Approximate number of Direct Support Professionals serving Prince George’s County residents as of July 2023

Total dues owed for Prince George’s Provider Council Membership FY24:

Agency:  *

Agency Representative Name :

Agency Mailing Address:

Agency Representative Email :

Agency Representative Preferred Phone # :

Please Note:  This form is only required if paying by check.  If paying by credit card - click here

I need some assistance with our dues submission

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Your form has been submitted - please include your printed copy with your check

Please make your check out to: Prince George’s Provider Council and mail  to:

Prince George’s Provider Council, Omar Nicholson
P.O. Box 1906
Beltsville, MD 20704

Prince George’s CountyDD operating budgeted  FY24*:


Agency Representative Name :

Agency Representative Email :

Total dues owed for Prince George’s Provider Council Membership FY24:

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