Membership Application

Print, fill out and mail to: ADAM, P.O. Box 303, Olney, MD 20832
Call (301) 924-2393 if you have any questions.

Name of Business:___________________________________________
Years in Business: ______
Business Address: ___________________________________________
City: _________________________ State: ____ Zip: ____________
County: ___________________ Business Phone: ___________________
Owner's Name(s): ____________________________________________
MD Trader's License: ______________________
MD Sales Tax License: _____________________
*Shipping Address:(if different from above) No P.O. Box numbers, please.
__________________________________________________________
__________________________________________________________
*Home Phone: ______________
*This information will not be used for advertising or publishing purposes.

Please give the name of two references who can attest to your character and business reputation.
1) Name: ______________________________ Phone: _________________
Address: ______________________________________________________
2) Name: ______________________________ Phone: _________________
Address: ______________________________________________________
Important Note: the Board of Directors must approve all applications for membership.

Please describe how you would like your business to be listed in the ADAM directory. (For examples refer to current directory or membership listings in this web site.)
Shop/Business Name: ____________________________________________
Address: ______________________________________________________
Phone numbers: ________________________________________________
Email: ________________________________________________________
Web site address: _______________________________________________
Hours of Operation: ______________________________________________
Description of your business (Up to 6 lines, 60 spaces each line.)
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Last line will contain: owners name(s) and the numbers corresponding to your shows in the directory. If you do not locate a Maryland or Northern Va. show that you participate in the current brochure or here in the web site, please list those shows with date, name and contact person with phone number on a separate paper and attach. Thank you.

Please read and sign the following:
The information provided by me on this application is accurate and if accepted for membership in the Antique Dealers Association of Maryland, Inc., I will abide by the laws and Code of Ethics of the Association. I understand that breach of the by-laws and Code of Ethics could result in the termination of my membership and forfeiture of any fees paid. Please consider my application for membership in ADAM. Enclosed is my check, made payable to ADAM in the amount of $ ______ (See Dues Structure page.)

Signed: ______________________________________________________
Title: __________________________ Dated: ________________________

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