Membership

SHAPE New Mexico (formerly NMAHPERD)
MEMBERSHIP APPLICATION
***Includes $1 Million dollar liability insurance policy for all professional memberships***
Please Print Clearly or Type; Must be complete

Name Last___________________________ First_______________________________Initial_________

Home Address
Street________________________________ City______________________ State_____ Zip__________

Work Address
Street________________________________ City______________________ State_____ Zip__________

School/Agency______________________________ School District (if applicable)___________________

Phone: (W)__________________ (H)______________________ (C) _____________________________

_______ Please check if you do NOT want to receive texts from NMAHPERD

Preferred E-Mail Address (legible!) _________________________________________________________

New Member ________ Renewal_________ # of yrs.? _________ SHAPE America Member (Y/N)____

PROFESSIONAL INTEREST AREA: (check all that apply)
Health _______ Exercise Science _______ Wellness _______
Physical Educ. _______ Athletics/Coaching _______ Fitness Industry _______
Recreation _______ Administration _______ Athletic Training _______
Dance _______ Adapted PE _______ Sports Med./PT _______

TEACHING/WORK LEVEL: (check those that apply)
Elementary ______ Community College _______ Business _______
Mid School _______ University _______ Retired _______
High School _______ Early Childhood _______ Full Time Stud. _______

MEMBERSHIP DUES: (check one)
_______Professional ($40.00)
_______Student—NON VOTING ($10.00) (advisor verification/institution)_________________________
_______Associate—NON VOTING ($20.00) (professionals in non HPERD fields)
_______Retired ($20.00) (Retired from HPERD Field)
_______Emeritus (FREE) (Must meet criteria)

GET INVOLVED … MAKE A DIFFERENCE IN NMAHPERD
(Check those that you are interested in)
NMAHPERD Board ______ Convention Planning ______ Legislative Network ______
Public Rel./Advocacy ______ Convention Program ______ Convention Presenter ______ Traveling Team Presenter ______ College Recruitment ______ Other (explain) ______

THANK YOU! PLEASE RETURN COMPLETED MEMBERSHIP FORM AND CHECK
PAYABLE TO:
NMAHPERD
PO Box 27040
Albuquerque, NM 87125-7040
E-mail: nmahperdexecdirector@gmail.com

%d bloggers like this: