Nebraska Association for Health, Physical Education, Recreation and Dance

(Electronic registration is not available at this time)
or
Download pdf Membership Application here
or

Print out and send completed form and a check for the membership fee payable to NAHPERD to:
NAHPERD
8202 S. 87th Street #7
LaVista, NE 68128

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
Jump Rope for Heart/ Hoops for Heart Coordinator ( note: $20.00 off a one year membership)
Membership #:

PLEASE PRINT
Title: Ms. Mrs. Mr. Dr.
Name
Address
City/ State/ Zip
Phone Number
Alternate Phone Number
Email Address
Place Employed
Names of Department Chair:
Major’s Club Sponsor:
If Applicable: I have conducted JRFH and/or HFH for (List Years)

(Students Only)
College/University attending:
Public ___ Private ____
Names of Department Chair:
Major’s Club Sponsor:
Year in School: Fresh Soph. Jr. Sr. Grad Student

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I would be willing to serve NAHPERD in one or more of the following roles (Please check all interest areas below)
President-Elect	Future Professional Advisor
Health VP-Elect	Strategic Plan Committee
Dance VP-Elect	Secretary
Physical Education & Sport VP-Elect	Archivist/Historian
Exercise Science & Wellness VP-Elect	Grant Committee
Recreation VP-Elect	Admin. Structure & Function Committee