Name: ______________________________________________________________________

Address:  ____________________________________________________________________

________________________________________________________________________

Telephone  H:  _________________________  W:  ______________________________

Fax:  _______________________________________________________________________
 

I would like to volunteer to serve on the following committees:

Other areas of interest
 

Please print this form and FAX or mail to:
 

MASL
P.O. Box 21127
Catonsville, MD 21228

Dorothy D'Ascanio
900 Jackson Road
Silver Spring, MD 20904