LIRID Membership Form 2022-2023
Welcome! Please fill out the following form entirely to become a member of LIRID. Once submitted, you will be directed to complete Dues payment via PayPal. You must submit both the form and payment to be considered a member in good standing of LIRID.

You will receive an email copy of your form response and a receipt from PayPal. Thank you for joining LIRID!

Please contact Alyssa, with any questions or concerns.
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Email *
Name *
Street Address *
Town, State, Zip *
Mobile Phone
Work Phone
Home Phone
Certifications *
Please Select all that apply
Additional interpreting credentials
(ex: SC:L, Trilingual, EIPA [include score], Etc.)
RID Member Number *
If applying as a supporting or organizational member, please type 000
Please Select Any Information You Wish to be Included on the LIRID Website Registry *
Any information you do not select will remain confidential
Membership Categories *
Volunteers Needed! Please check any area you feel you could help. A committee member will contact you:
A copy of your responses will be emailed to the address you provided.
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