Affiliate Application Form

Instructions

Completing this application in its entirely will help GPBR serve you more quickly. Upon receipt of this application, staff will process your application and will be in touch with payment instructions. Your account will not be active unless your invoice has been paid in full.

Need Help? Call us at 207-775-1097.

Select An Option

Primary Affiliate $322 Annually

Secondary Affiliate Membership $223 Annually

If you are an Affiliate member who pays dues to another Association (your primary membership) within the State of Maine wishing to hold secondary membership with this Association, please select this option.

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameOffice Name

Please select a valid membership option and fee item if exist

Affiliate Application Form

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