The following form is in pdf format. You must have Adobe Reader to view it. 
You must have Adobe Reader 6.0 or greater to fill it out on-line.
Once you complete the form you can sent it to us by:
Printing it out using the button above and faxing it to Tamara Keane at (401) 462-8818
or
Saving it to a file by using the button above and e-mailing it to Tamara Keane
Adobe Acrobat 6.0 or greater is required to save the completed form to a file.
Click here to access the form as a Word Document |