NEW MEMBER APPLICATION

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Phone

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Attestation*

To the Maryland State Funeral Directors Association, Inc:
Having formed a favorable opinion of your Association, I hereby make application to become a member, and if my credentials are found to be in order, I agree to abide by the Constitution and By-Laws and the Code of Professional Conduct. I've completed this application in its entirety and submit it for your review.

I agree

Name*

Prefix First Middle Last Suffix

Email*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone*

Cell/Mobile Phone*

Birthday*

Month and day

Business Name*

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Phone*

Business FAX

Business Email

If different from email listed above.

Number of Years In/With Business*

Enter the number of years you've been in business, or have been in the employ of the above-named business.

Maryland Funeral License #

License #

Active or Inactive?

Expiration Date

Are you licensed in another state?*

Yes

Other State Licenses

Enter the other states and the funeral service license numbers. Click the + icon to add additional rows if needed.

State

License #

Academy of Professional Funeral Service Practice (APFSP) #

Certifications

Check the box if you hold the certification

CFSP (Certified Funeral Service Practitioner)

CCO (Certified Crematory Operator)

CCSP (Certified Cremation Service Provider)

CPC (Certified Preplanning Consultant)

Are you a recent graduate of a Mortuary School?*

Yes

Mortuary School Information

Name of School

Graduation Date

Type of Business*

Sole Proprietorship

Partnership

P.A.

Corporation

Additional Individual

Business Officers

If a corporation or partnership, please list the names and titles of all officers and designates (Y/N) which officers hold MSFDA Category I or I-A membership.

Officer Name

Officer Title

I or I-A (Yes or No)

Academy of Professional Funeral Service Identification #

Vouched For By*

Please list the names and phone numbers of 2 MSFDA Members who will vouch for your application. Click the + on the right to add another row for your 2nd person.Not sure who is a member Contact MSFDA at 410-553-7706

Name

Phone Number

Membership Category

Please check one of the following membership options.*

A funeral home establishment (Firm) must have (1) Category I or I-A member. Membership category descriptions can be reviewed here. Later on this form, you will be able to add your Firm's licensed funeral directors who can use your Firm's membership to participate in free or discounted continuing education programs offered by MSFDA.

Firm - Category I ($925)

Firm - Category I-A ($695)

Individual - Category II ($295)

Individual - Category III ($120)

Associate ($225)

Out of State ($225)

Honorary Associate (First Year Licensee) ($0)

Student Membership ($0)

Firm Category I New Member

Price:

Firm Category I-A New Member

Price:

Individual Category II New Member

Price:

Individual Category III New Member

Price:

Associate New Member

Price:

Out of State New Member

Price:

Honorary Associate New Member

Price:

Student New Member

Price:

Category I Firm Membership Additional Eligible Directors

Please list below your Firm's 2nd Voting Members and ALL of your Firm's licensed funeral directors who would be eligible to participate in MSFDA's continuing education programs at the member's discounted rate.

2nd Voting Member for Your Firm

Prefix First Middle Last Suffix

2nd Voting Member Email

Position

Owner, VP, Manager, Staff Funeral Director, etc

Birthday

Month and day

Mailing Address for 2nd Voting Member

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Funeral Service License #

License #

State

Expiration Date

Academy of Professional Funeral Service Practice (APFSP) #

Certifications

Check the box if your 2nd Voting Member holds the certification

CFSP (Certified Funeral Service Practitioner)

CCO (Certified Crematory Operator)

CCSP (Certified Cremation Service Provider)

CPC (Certified Preplanning Consultant)

Additional Licensed Funeral Directors

Click the + symbol after each director if you need to add another. If you have more than 25, please contact the MSFDA office.

Name (First & Last)

Funeral Service License # (1)

Funeral Service License # (2)

APFSP #

Category I-A Firm Membership Additional Eligible Directors

Please list below up to three (3) of your Firm's licensed funeral directors who would be eligible to participate in MSFDA's continuing education programs at the member's discounted rate.

Additional Directors

Click the + symbol after each director if you need to add another (up to 3).

Name (First & Last)

Funeral Service License # (1)

Funeral Service License # (2)

APFSP #

Authorization to Fax and/or Conduct Telephone Solicitation

Please make a choice below.*

The guidelines implemented by the Federal Communications Commission (FCC) for communicating via fax require prior written consent to enable associations to fax information.

Yes, I authorize the MSFDA to fax information to me, which may include but is not limited to membership dues renewal, educational seminar, convention, event, and program notices. My fax number is listed on my application.

No, I do not wish to receive information via fax nor participate in telephone solicitation.

Notice Regarding Tax Deductibility of Dues

MSFDA dues are not deductible as a charitable contribution for federal tax purposes, but may be deductible as business expenses.

Generally, funeral homes that pay MSFDA dues can deduct 100% of those dues as ordinary business expenses for federal tax purposes. However, due to the Budget Revenue Reconciliation Act of 1993 (the “Act”), any dues revenues utilized by a professional or trade association for lobbying purposes cannot be deducted by the member who paid the dues.

In accordance with the Act, the Maryland State Funeral Directors Association is hereby notifying its membership that it estimates that 8.45% of MSFDA 2026 dues is not deductible as ordinary business expenses for federal tax purposes. This estimate is to be utilized by MSFDA members in determining what portion of their MSFDA dues is deductible. Please provide a copy of this notice to your accountant and tax preparer.

I have read the above information concerning tax deductibility of MSFDA dues.*

Yes

Signature of Applicant

Signature*

Date*

Month

Day

Year

Payment Information

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Total

Credit Card

Card Details

Cardholder Name

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