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UAHPERD Membership Form
Last Name:
First Name:
Street:
City:
State:
ZIP:
Home Phone:
Office Phone:
Email Address:
University or School District:
Area of Specialization
Health
Physical Ed.
Sport
Dance
Physical Activity & Recreation
Would you be interested in serving on the UAHPERD Board?
Yes
No
Classification
Professional
$15.00
Student
$10.00
Other
Total Enclosed:
Please complete all information, print, and mail to:
UAHPERD c/o Geri Conlin
Weber State University
2801 University Circle
Ogden, UT
84408-2801
Please make the check payable to "
UAHPERD
"
