Workshop Registration: (Circle below) (Session 2: November 28, 2011, Warwick Public Library)
11/5/11 Member Attendee: FREE 11/5/11 Non member Attendee: $30 (Membership, see below)
Member Professional $30.00 Student* $15.00
Non member $60.00 Become a member ($30.00) and pay only $30.00
NO ONSITE REGISTRATION: All registration to be postmarked by November 24, 2011.
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RIAHPERD Membership Form — Membership Year: September 01 - August 31
Name: ____________________________________________________ Title: ______________
Home Address: _________________________________________________________________
City: ______________________________________________ State + Zip Code: ____________
Telephone: _______________________________ Email: _______________________________
Business Address: ______________________________________________________________
City: _________________________________________ State + Zip Code: _________________
Telephone: __________________________ Email: ____________________________________
*Please add my name to the RIAHPERD Listserv: YES NO
*Please check one: ________ Renewal ________ New Membership
Membership Category: (Circle one)
Professional $30.00 Student* $15.00 Retired $15.00 Lifetime $300.00
Employer: _____________________________________________________________________
*Please provide following information:
Year of Graduation: ________________ From (college/university):______________________
Major(s): _____________________________________________________________________
Most Appropriate Discipline: (Please Circle)
Health Education Physical Education Recreation Dance Other
Mailing Preference: (circle one) Home Business
Make check/money order payable to RIAHPERD. Please include this form with payment to:
Kathy Kenwood, 8 Shelter Lane, Cumberland, RI 02864.