Membership Application Form for Learning Independence Through Computers (LINC)

Please printout application, and then mail your completed application and membership fee to:

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

For further information, call 410-659-5462

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?