Membership Application Application Date (mm/dd/yyyy format required) Your Name (required) Your Address (required) Your City, State & Zip ---NJNYPADE Your Email (required) Your Home Phone Your Cell Phone Your Message MEMBERSHIP WAIVER: (required) Resources for Independent Living (RIL) would like to use your photograph and/or name in our promotional material (newsletter, poster-board, etc.) Additionally, RIL would like to know if you are interested in sharing your phone number with volunteers via a phone tree. I give RIL permission to publish my photograph, name, address and phone number, if so needed.