Institutional Membership Application

Brief Institutional Introduction

Institution Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone Number

(###)

###

####

Website

http://

Institution Description

Designated Primary Board Member for MIEC

Name

First Name

Last Name

Title

Phone Number

(###)

###

####

Email

Designated Alternate Board Member

Title

Phone Number

(###)

###

####

Email

Instructions

After submitting the form, please send the MIEC Membership check ($2000) to:

Maryland International Education Consortium

C/O Jolanta Coffey

300 W Pratt Stree STE 300

Baltimore, MD 21201

You will be contacted by MIEC so we can add your institution to the MIEC’s website and other materials. Any questions about the MIEC membership should be addressed to info@studymaryland.org. Thank you for joining MIEC, we look forward to working with you!