Application
(Electronic registration is not available)
Print out and send completed form and check Membership Fees.
(payable to NAHPERD ) to:
P.O. Box 83333
Lincoln, NE 68501
Professional: $30 (1 year) $55 (2 years) $75 (3 years)
Student:/retiree $10 (1 year) $17.50 (2 years) $20 (3 years)
Member of AAHPERD? ___Yes ___No
Membership #: ____________________
Willing to serve NAHPERD? ___Yes ___ No
(Please check interest area below)
PLEASE PRINT
Mrs. Ms. Mr. Dr. (circle appropriate title)
Preferred Mailing Address ________________________________________________________
County __________________________
City/State ________________________ Zip _____________
Fax (___) ___________
Preferred Phone (___) ___________
e-mail: ________________________
Place Employed ___________________________________________________
Univ/College Attending Fr So Jr Sr Grad
Public ___ Private ____
Names of: Dep’t. Chair: ______________________
Major’s Club Sponsor: ________________
If Applicable: I have conducted JRFH and/or HFH for _____ Years.
< < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < <
I would be willing to serve NAHPERD in one or more of the following roles: (circle)
ELECTED OFFICE APPOINTMENTS= President Elect = Secretary = Future Prof. Advisor = Archivist/Historian= Treasurer = Parlimentarian = Grants Committee= Awards Committee = Public RelationsVice President Elect = Applied Strategic Plan = Admin. Struc/Funct= Health State Coordinators:= Phys. Ed & Sport = Allliance State Fitness (must have PB certif.)= Ex.Sci. & Wellness = Jump Rope/Hoops for Hear= Recreation = NAGWS= Dance
