Membership Application Form

Name(S) ____________________________________________________

EMAIL ADDRESS ____________________________________________________

(Will only be used for RIAC notification)

STREET ADDRESS ____________________________________________________

CITY, STATE & ZIP Manchester NJ 08759

Home Phone ___________________Cell phone_______________________

Areas of interest where you would be will to assist (Check if any)

Publicity

Entertainment for Meetings

Set Up For the Meetings

Refreshments

Suggestions for Programs at Monthly Meetings ________________________________

Attach Check for $10.00 Single membership or $20.00 per couple. Make checks payable to RHA. The application may be mailed to the following address or submitted at any meeting.

Patrick Scanlon

36 Saxony Circle

Manchester NJ 08759