RIAHPERD 80th Annual Fall Conference - Registration Form

Friday, October 27, 2006, at the Community College of Rhode Island, Warwick, RI

Name   Address

City State Zip

Phone E-mail Address

Do you possess a current RIAHPERD membership? Yes No  *

* If yes, check one:    Lifetime      Professional       Student    If no, you can find a membership form at:  http://www.riahperd.org/Membership.html.          

Are you a current AAHPERD member?  Yes No      AAHPERD #

EARLY BIRD REGISTRATION SAVES YOU MONEY! - EARLY BIRD Registration must be received by October 20 - No Exceptions

    $45 RIAHPERD member (early bird registration TBA)

    $65 RIAHPERD member (registration at the door)

    $65 Non-RIAHPERD member (early bird registration TBA)

    $85 Non-RIAHPERD member (registration at the door)

    $25 RIAHPERD Student member (early bird registration TBA) 

    $35 RIAHPERD Student member (registration at the door) 

    $35 Non-RIAHPERD Student (early bird registration TBA)

    $45 Non-RIAHPERD Student (registration at the door)

Continuing Education Credit: $10 CEUs from the Rhode Island Department of Education for K-12 teacher  Yes No

Membership Dues (You Can Become a Member At The Same Time) September 2006 to August 31, 2007.

      $30 RIAHPERD (Professional member)             $15 RIAHPERD (Student member)

Total Amount  $ (make check out to RIAHPERD Fall Conference 2006)

Which day would you prefer for a conference next year?  Friday , or Saturday ?

Please print this form and send it and the check to:

Linda Grossi, 110 Pilgrim Parkway, #3, Warwick, RI 02888