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MEMBERSHIP APPLICATION

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

  • If paying by check, please print and fill out the PDF form and mail your dues check with the form.

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        The mailing address is:

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

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  • 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.

Membership Form

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