2016 MEMBERSHIP APPLICATION/INFORMATION
NEW: RENEWAL:______XXX______
NAME:Kerry Horne, M, Ed,OFFICIAL TITLE:Executive Director
NAME OF DEPARTMENT/COMPANY:New Hampshire Recreation & Parks Association
BUSINESS ADDRESS:, ,
TELEPHONE:603-340-5583FAX NUMBER:
E-MAIL ADDRESS:
WEB SITE:
APPLYING FOR: PROFESSIONAL MEMBERSHIP($ 25.00)
COMMERCIAL MEMBERSHIP($ 50.00)
Max. $ 100.00 per agency.
STUDENT MEMBERSHIP($ 5.00)
XXX COMPLIMENTORY(NO FEE)
SIGNATURE: DATE: ______
SEND (PAYABLE) TO:NEW ENGLAND PARK ASSOCIATION, INC.
WICKHAMPARK
1329 WEST MIDDLE ROAD TURNPIKE
MANCHESTER, CT06040
Federal Taxpayer ID# 22-3035073
PLEASE COMPLETE AND RETURN ASAP
2016 MEMBERSHIP APPLICATION/INFORMATION
NEW: RENEWAL:______XXX______
NAME:Deb SmithOFFICIAL TITLE:Executive Director
NAME OF DEPARTMENT/COMPANY:Maine Recreation & Park Association
BUSINESS ADDRESS:P.O. Box 6728, Scarborough, ME004070
TELEPHONE:207-252-0636FAX NUMBER:
E-MAIL ADDRESS:
WEB SITE:
APPLYING FOR: PROFESSIONAL MEMBERSHIP($ 25.00)
COMMERCIAL MEMBERSHIP($ 50.00)
Max. $ 100.00 per agency.
STUDENT MEMBERSHIP($ 5.00)
XXX COMPLIMENTORY(NO FEE)
SIGNATURE: DATE: ______
SEND (PAYABLE) TO:NEW ENGLAND PARK ASSOCIATION, INC.
WICKHAMPARK
1329 WEST MIDDLE ROAD TURNPIKE
MANCHESTER, CT06040
Federal Taxpayer ID# 22-3035073
PLEASE COMPLETE AND RETURN ASAP
2016 MEMBERSHIP APPLICATION/INFORMATION
NEW: RENEWAL:______XXX______
NAME:Betsy Terry, CPRPOFFICIAL TITLE:Executive Director
NAME OF DEPARTMENT/COMPANY:Vermont Recreation & Parks Association
BUSINESS ADDRESS:721 Main Street, Colchester, VT005446
TELEPHONE:802-878-2077FAX NUMBER:802-878-2921
E-MAIL ADDRESS:
WEB SITE:
APPLYING FOR: PROFESSIONAL MEMBERSHIP($ 25.00)
COMMERCIAL MEMBERSHIP($ 50.00)
Max. $ 100.00 per agency.
STUDENT MEMBERSHIP($ 5.00)
XXX COMPLIMENTORY(NO FEE)
SIGNATURE: DATE: ______
SEND (PAYABLE) TO:NEW ENGLAND PARK ASSOCIATION, INC.
WICKHAMPARK
1329 WEST MIDDLE ROAD TURNPIKE
MANCHESTER, CT06040
Federal Taxpayer ID# 22-3035073
PLEASE COMPLETE AND RETURN ASAP
2016 MEMBERSHIP APPLICATION/INFORMATION
NEW: RENEWAL:______XXX______
NAME:Valerie Stolfi-CollinsOFFICIAL TITLE:Executive Director
NAME OF DEPARTMENT/COMPANY:Connecticut Recreation & Parks Association
BUSINESS ADDRESS:135 Day Street, 2nd Floor, 2H, Newington, CT006111
TELEPHONE:860-721-0384FAX NUMBER:860-529-8708
E-MAIL ADDRESS:
WEB SITE:
APPLYING FOR: PROFESSIONAL MEMBERSHIP($ 25.00)
COMMERCIAL MEMBERSHIP($ 50.00)
Max. $ 100.00 per agency.
STUDENT MEMBERSHIP($ 5.00)
XXX COMPLIMENTORY(NO FEE)
SIGNATURE: DATE: ______
SEND (PAYABLE) TO:NEW ENGLAND PARK ASSOCIATION, INC.
WICKHAMPARK
1329 WEST MIDDLE ROAD TURNPIKE
MANCHESTER, CT06040
Federal Taxpayer ID# 22-3035073
PLEASE COMPLETE AND RETURN ASAP
2016 MEMBERSHIP APPLICATION/INFORMATION
NEW: RENEWAL:______XXX______
NAME:JohnM.Whalen, Jr., CPRPOFFICIAL TITLE:Executive Director
NAME OF DEPARTMENT/COMPANY:Massachusetts Recreation & Park Association
BUSINESS ADDRESS:P.O. Box 783, Westfield, MA001086-0783
TELEPHONE:413-568-8356FAX NUMBER:413-568-4166
E-MAIL ADDRESS:
WEB SITE:
APPLYING FOR: PROFESSIONAL MEMBERSHIP($ 25.00)
COMMERCIAL MEMBERSHIP($ 50.00)
Max. $ 100.00 per agency.
STUDENT MEMBERSHIP($ 5.00)
XXX COMPLIMENTORY(NO FEE)
SIGNATURE: DATE: ______
SEND (PAYABLE) TO:NEW ENGLAND PARK ASSOCIATION, INC.
WICKHAMPARK
1329 WEST MIDDLE ROAD TURNPIKE
MANCHESTER, CT06040
Federal Taxpayer ID# 22-3035073