( PLEASE PRINT OR TYPE ) Membership Application _________________________________________________________________ Name of Candidate for DCSOMS Membership Degree (s) _________________________________________________________________ Primary Office Address Suite Number City State Zip Code _________________________________________________________________ Office Telephone Number Fax Number Primary Email Address _________________________________________________________________ Home Address Apartment Number City State Zip Code _________________________________________________________________ Home Telephone Number Fax Number Home Email Address Signature: ______________________________________Date:_______________ MAIL COMPLETED FORM TO: Jeanne A. Perrotta Executive Secretary 2311M Street NW Suite 200 Washington, DC 20036 jeanneperrotta@mac.com www.dcomfs.org