Nebraska Association for Health, Physical Education, Recreation and Dance

(Electronic registration here)
or
Download pdf Membership Application here
or

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

Professional: $35 (1 year)
Student/Retiree: $15 (1 year)
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