Next RIAHPERD Workshop Series TBA
Membership Year: September 01 - August 31
Name: __________________________________________________________ Title: ____________________________________________________________
Home Address:
_____________________________________________________________City/Town__________________________________State_________
Telephone: _________________________________________ Email:
_________________________________________________________________________
Business Address:
___________________________________________________________City/Town__________________________________State_________
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
APE Recreation
Dance Other
Mailing Preference: _______Home _______Business
Workshop Registration:
_______Professional $30.00 _______Student* $15.00
_______Non member $40.00
Onsite:
_______Professional $35.00 _______Student* $15.00
_______Non member $45.00
Limited space will be available for onsite
registration. Sign up early.
Make check/money order out to RIAHPERD and return this form to: (or print this out and bring it with you!)
Linda Grossi, 110 Pilgrim Parkway, #3,
Warwick, RI 02888