RIMAP MEMBERSHIP FORM

Name_______________________________________________

Address_____________________________________________

City________________________________________________

State____________________ ZIP_______________________

Diver____________________ Non-Diver_________________

Phone____________________ FAX_____________________

E-mail _____________________________________________

I am a diver ________ I am not a diver ________

RIMAP membership fee of $25 (Required for class and volunteer participation)

RIMAP Membership ($25) + Donation = ________ Total Enclosed

Please printout this form, make checks payable to RIMAP and mail it to:

RIMAP
PO Box 1492
Newport, RI 02840