CAHPERD
Membership Form


Welcome to CAHPERD!

Please print out this form and fill it in. Send the completed form with your convention application and your check (made payable to CAHPERD) to:

CAHPERD Convention Registration
6592 Benton Circle
Arvada, CO 80003


Beginning in 1998, all CAHPERD memberships will expire on August 31st of each year and be current for one calendar year.



CAHPERD Membership Form

Please Print or Type


Name:

Membership Expiration Date:

Address:


Home Phone:

Fax:

School/Org:

Position:

Work Phone:

E-Mail:

County:

District:


Check box if you consent to name/address/phone being printed in the professional member directory. Forms received pror to its printing will be included this time.


Membership Dues (check one)

REGULAR $40 (For persons professionally engaged in areas covered by the Association)

FIRST YEAR $20

DISCOUNT REGULAR $20 (For persons professionally engaged in areas covered by the Association who have either

  1. Hosted a Jump Rope of Hoops For Heart event within the last year or;
  2. Recruited a colleague who was not a member the previous year.)

    Date of Jump: Name of Colleague:

RETIRED $20

STUDENT $10 (For full-time students preparing for a profession in areas covered by the Association.)



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