The
RHODE ISLAND
6 ARNOLD ROAD, COVENTRY, RHODE ISLAND 02816
[Form elements marked with
*
are required and must be filled in.]
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First Name:
*
Last Name:
Middle Initial:
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Age:
(
Note:
)
Spouse Name:
*
Address:
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City:
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State:
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Zip:
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Home Phone + Area Code:
Cell Phone + Area Code:
*
E-mail:
Subscribe to RISAA E-mail list:
Yes
No
*
Occupation:
Employed At:
How did you hear about RISAA?
(chk all that apply)
Friend:
Tackle Shop:
Facebook:
News Article:
RISAA Newsletter:
Fishing Show:
Web site:
Ad On Internet:
Ad On TV:
Ad In Magazine:
Other:
Prefer to fish from
: (check all that apply)
Rocks and Piers:
Party or Charter Boat:
Surfcasting:
Other:
Own Boat - length:
Maker/Type:
Boat Name:
Docked At:
Check All That Apply
:
(Note: additional members, immediate family, same household = $45.00)
New Membership
Membership Renewal
Regular Adult $50.00/year
Regular Adult 2 Years $90.00 (Save $10)
Regular Adult 3 Years $135.00
Regular Adult Age 65+
$25.00/year (must supply DOB in Note section below)
Life Member
$500.00 one time payment
2nd Member of Family
$45.00/year
Junior Member - Free
(Up to 17 years. Requires member sponsor and signature of parent).
*
Note (Gift, paying for someone else, etc):
*
Payment By:
Visa
Mastercard
*
Credit Card Number:
*
Name on credit card:
*
Expiration Date:
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CVV Number on Back of Card
:
Learn how to find this number by clicking
HERE
