RID PINRA Form
Email additional information to cmp@alrid.org
Email address *
Participant name *
Your answer
Participant address *
Your answer
Participant phone number *
Your answer
RID Member ID *
Your answer
Activity Title *
Your answer
Activity/Conference Theme or Focus (send brochure or flyer via email) *
Your answer
Website for event
Your answer
Activity start date *
MM
/
DD
/
YYYY
Activity end date *
MM
/
DD
/
YYYY
Activity start and end time (include all scheduled breaks) *
Your answer
Workshop Description *
Your answer
I certify that this activity/conference represents a valid and verifiable Continuing Education Experience that exceeds routine employment responsibilities. (Typing your name will serve as an electronic signature.) *
Your answer
Submit
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