ARID Membership Form 2002-2003

Arkansas Registry of Interpreters for the Deaf

P O Box 46511
Little Rock, Arkansas 72214-6511

Annual Membership Application
Membership year runs July 1st through June 30th.

Please complete the fields below, print this page, and return it with your membership payment.

Membership Types and Annual Dues Information:

Voting - Annual dues $25
RID Member Copy of RID membership card enclosed

Supporting - Annual dues $15

First Name: Last Name:
Address:
City/State/Zip:
Home phone (with area code):
Work phone (with area code):
Cell/Pager (with area code): (Please indicate 'cell' or 'pager' for numbers listed.)
Fax (with area code):
Email:

Certifications (Please list complete information regarding all current interpreting certifications you hold.):

RID Membership #:

Code of Ethics Statement
By joining, I agree to adhere to the RID Code of Ethics.

Payment Method:
Cash Money Order

Voting ($25.00)

Supporting ($15.00)

Donations:

Total Enclosed:

For Office Use Only

Date payment received: __________ By: _____
Date deposit made: __________ By: _____
Date membership entered into ARID database: __________ By: _____
Membership card sent: __________ By: __________

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