Maryland Locksmith Association, Inc. Association 2016 Dues Invoice
 437 Westside Blvd Catonsville, MD 2128301-345-2272Fax 240-331-0330

Dear Member Locksmith,

Your 2016 membership dues must be paid by January 31, 2016 to be included in the membership roster and to receive your web site access password. Please complete the section below so we may list your information correctly in the member roster. Also please note there is a section for the “Find A Locksmith” area of our website. Please include the information that you would like to appear on our website for the public to see. Also included in this year’s renewal is the opportunity to register to obtain an MLA License Tag from the Maryland MVA.  
We must have at minimum 25 License Tags sold before the MVA will allow us to place our order. If you are interested in obtaining a tag please send an additional $25.00 per vehicle that you would like MLA tags for.
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Member Locksmith Association Renewal Form 2016Extended Due Date 2/15/2016
Please return this portion with your check, money order or credit card information

Item Amount DueAmount Included
Standard Dues$100.00$_____________
Shop Employee Dues$ 50.00$_____________
MLA MVA Tags$ 25.00/Vehicle$___________ How many vehicles ____TOTAL Amount Enclosed$_____________

Member#:______DLLR Lic #______MLA Tag#______ALOA #:______SAVATA #:______
Have you been convicted of a felony or misdemeanor in any State, the District of Columbia or Federal Court since your last renewal?No ______Yes ______
Name:________________________________________________________
Business Name:________________________________________________
Employer Name:________________________________________________
Address:______________________________________________________
City:______________________ State:________ Zip Code:_____________
Telephone: Work:____________________ Mobile:____________________
E-Mail:_______________________________________________________

□ Check No.________□ Master Card□ Visa□ American Express
Card Number: ________________________________________Expiration:___/___
Verification Code ________ (on back of card)Address associated w/ credit card
MLA Web Site Listing: How would you like to appear to the public on our web site?
Business Name:________________________________________________ DLLR #_________________
Address: (Optional)_____________________________________________________________________
Telephone Number:_________________________Web Site:___________________________________
Services you offer: □ Automotive□ Residential □ Commercial□ Safe & Vault
□ Government Services□ Other: ____________________________________
MLA Renewal Form #002 Rev 2015

The Maryland Locksmith Association