MARYLAND BOARD OF MORTICIANS AND FUNERAL DIRECTORS

MARYLAND BOARD OF MORTICIANS AND FUNERAL DIRECTORS

REQUEST FOR ROSTER LIST

The roster contains the name, mailing address, initial license date and expiration date of those licensees that have granted the Board permission to be on the roster.

Active & Inactive Roster Request Fee: $55.00

PAY HERE: https://mdbnc.health.maryland.gov/mort_pay/Pay_fee_roster.aspx

If requesting more than one roster, please submit a request form and payment receipt for each roster request.

Lists are available in Excel format and are sent electronically.

Contact Name*

Contact Email*

Contact Phone Number*

Roster Type*

The roster contains the name, mailing address, initial license date and expiration date of Active and Inactive licensees that have granted the Board permission to be on the roster.

*If requesting more than one roster, please submit a request form and payment receipt for each roster request.

Select

Requesting Board or Entity Information*

Please provide the following information where the Roster may be sent:

Email Address (Lists are available in Excel format and are sent electronically.)

File Upload*

Copy of payment receipt.

There is non-refundable Roster Request fee of $55.00 per request.

Please make a payment using the link below. Once complete please upload a copy of your receipt to the box below.

Roster Request Payment Link

Drag and drop files here or

Send me a copy of my responses

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