Get TX TAHPERD Membership Application

MEMBERSHIP APPLICATION 7910 Cameron Road Austin Texas 78754 Ph 512 459-1299 Fax 512 459-1290 www. tahperd. Professional Membership J Associate Membership Non-Certified Teachers and Personnel J Student-to-Professional Membership 2-year J Student Membership Student MUST be a FULL-TIME student J Retired Membership Contact TAHPERD State Office for eligibility criteria. Payment Information Check enclosed payable to TAHPERD Credit Card Exp. Date Signature Completed 1. org Name Work Phone Number ISD/University/Other Employer Home Phone Number Campus/School Name Cell Phone Number Home Mailing Address E-mail Required for receiving HPERD Newsletters City/State/Zip Ethnicity For Grant Purposes Gender For Grant Purposes Birth Year For Grant Purposes Teacher Certification Year If a Previous TAHPERD Member Member ID Expiration Date PROFESSIONAL MEMBERS ONLY Instructions Please use the corresponding numbers in the columns below to select the best description in each category. PRIMARY Job Description Classification Primary Interest choose one 1. Teacher/Professor 2. Athletic Coach 3. Athletic Trainer/Sports Medicine 4. Administrator 5. Teacher s Aide 6. Recreation/Parks Staff 7. Hospital/Clinic Staff 8. Private/Volunteer Agency 9. Corporate/Private Fitness 10. Other SECONDARY Interest Highest Degree Completed 1. Elementary 2. Middle School 3. Secondary 4. Community/Junior College 5. College/University 6. Government Office/Agency 8. Other PRIMARY Interest Physical Education Athletics Research Dance Recreation Health Adapted/Special Programs Please Check the Boxes that Apply MEMBERSHIP OPTIONS CHECK ONE J Professional Membership One Year Certified Teachers and Professionals J 5 yr. Bachelors 2. Masters 3. Doctorate My school has a School Health Advisory Council SHAC My SHAC meets on a regular basis I coordinate a Hoops for Heart event I coordinate a Jump Rope for Heart event I am a Physical Education Coordinator or similar I am a college majors club sponsor If Paying with a School Purchase Order Please Read the Following Individual application forms for each attendee must be attached to all school purchase orders. All checks sent to the State Office by a school district must attach copies of each attendee s application form* Original/Copy of original PO Required* Requisition or travel vouchers for P. O. s are NOT accepted documentation* Billing Address MUST be on the purchase order. FOR TAHPERD OFFICE USE ONLY CC AP PO. org Name Work Phone Number ISD/University/Other Employer Home Phone Number Campus/School Name Cell Phone Number Home Mailing Address E-mail Required for receiving HPERD Newsletters City/State/Zip Ethnicity For Grant Purposes Gender For Grant Purposes Birth Year For Grant Purposes Teacher Certification Year If a Previous TAHPERD Member Member ID Expiration Date PROFESSIONAL MEMBERS ONLY Instructions Please use the corresponding numbers in the columns below to select the best description in each category. PRIMARY Job Description Classification Primary Interest choose one 1. Teacher/Professor 2. Athletic Coach 3. .