Glen Burnie Improvement Association, Inc
19 Crain Highway South 
Glen Burnie, Maryland 21061

                        APPLICATION FOR MEMBERSHIP

The undersigned respectfully requests admission to membership in the
Glen Burnie Improvement Association, Inc., and agrees to conform to 
the By-laws and Constitution of the Association and to work with the
members in the interest of the community.

____________________________________________________________________
NAME

____________________________________________________________________
STREET ADDRESS

_________________________________     ______________________________
TELEPHONE NUMBER                      PROPOSED BY

(please indicate name of any
household members on mailing list)__________________________________

COMMITTEE INTERESTS: (Please check all that apply)

____ Urban Renewal      ____ Legislation         ____ Carnival
____ Zoning Permits     ____ Culture             ____ Membership
____ Liquor Licenses    ____ Boy/Girl Scouts     ____ Girl Scouts
____ Parks and Trees    ____ Fire Protection     ____ Airport
____ Crime Prevention   ____ Education/Schools   ____ United Council
____ Clean up           ____ Youth Activity           of Civic Assoc.
____ Police-Community Relations

OTHER INTERESTS:____________________________________________________

      ______________________________________________________________

Application Fee $1.00 ____  Issed Certificate and Card No. _________

1st Reading ______________  Elected _________________