**** RENEWALS ARE DUE JANUARY 1 OF THE MEMBERSHIP YEAR ****

Name:______________________________________________Phone:__________________________

Address:____________________________________________State________ZipCode:__________

Email Address_____________________________________Renewal_________New____________

Individual: $20._______Junior $10.________Family Membership $25.____________

Please list family members:_________________________________________________________

MARISA Affiliate Membership $40.___________________________________________________

Member of ASHA: Yes_______ No_______ 

Please make check payable to MARISA, mail to:
Marge Mullen, 97 Massasoit Ave., Barrington, Rhode Island 02806

Membership in MARISA (a Charter Club of the ASHA) gives you $10. off your ASHA membership.

For additional information please call 401-247-7789 or email redmm97@cox.net  

Website address www.marisaonline.org.