Arkansas Registry of Interpreters for the Deaf
P.O. Box 46511 
Little Rock, AR  72214-6511
Annual Membership Application  2002-2003 Fiscal Year

* Return theses page with your membership payment.

* Membership Types & Annual Dues Information: 

_____ Voting - annual dues $35.00
     ___ RID Member ___Copy of RID membership card enclosed
     Voting membership carries the privilege of voting for officers and issues
of concern at ARID business meetings.  Voting members must be RID members in
good standing in any category.  Verification of RID membership is required. 
(Please enclose a copy of your RID membership.)

_____ Supporting - Annual dues $25.00
     Supporting membership carries all the privileges and benefits of voting
membership except for voting rights.  Supporting members are encouraged to
join RID, but are not required to do so in this category.

* Please complete all of the following information.

Name:__________________________

Address:  _________________________

          _________________________

Email Address:__________________________________________________________

Home Phone:    ____________________________

Work Phone:    ____________________________

Cell/Pager: ____________________________________________________________
(please indicate "cell" or "pager" for numbers above)

Fax Number:    ____________________________

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

_____________________________________________________________________________

RID Membership #:____________________________



Please indicate the year you first joined ARID. ____________________________

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


*Payment Method:
_____ Check  or  ____ Money Order  

Payment Information: 
    
Voting ($35.00) _______

Supporting ($25.00) _______

Donations _______

Total Enclosed _________

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For Office Use Only
Date payment received: _____ By:_____
Date deposit made: _____  By:_____
Date membership entered into ARID database: _____  By: _____
Membership card sent: _____ By: _____

Form date: 4/23/03