Membership Application Form for Learning Independence Through Computers (LINC)

LINC Learning Independence Through Computers

If you prefer to print and mail your application, it is available in pdf format get the membership application in pdf format

Please mail your completed application and membership fee to:

Learning Independence Through Computers (LINC)
1001 Eastern Avenue, 3rd Floor
Baltimore, MD 21202

For further information Phone: 410-659-5462, TTY: 410-843-0219

Name		Date of Birth
Address:		Home Phone
City, State, Zip		Work Phone
Place of Employment/School		e-mail
If the applicant is a dependent, please provide:
Mother's Name		e-mail
Place of Employment		Work Phone
Father's Name		e-mail
Place of Employment		Work Phone
How did you hear about LINC?