When completing the membership form, please use Arial Narrow font set at 8 points.
Please note that our membership goes from January 1st to December 31st, which means that your membership now will be paid for 2011, January 1st to December 31st.
First Name		Middle Initial		Last Name		
						
Highest Degree		Department		Street Address		
	
College or University		City		State		Zip Code		
	
Office Phone		FAX		Email			
					
	Website				
					
If you wish to have your NAKPEHE publications sent to your home address, please input your home address below.	
	
Street Address		City		State		Zip Code		
						
In the section below, make one check for each of the information options that apply to you	
						
Institution (Check one)	4 Year College/University		Junior/Community College		Other			
						
Rank (Check one)	Instructor		Assistant Professor		Associate Professor		Professor		Other		
	
Age (Check one)	22-35		36-46		47-55		56-65		Over 65		
					
In the section below, please check your primary area(s) of responsibility	
	
Adapted PE		Administration		Anatomical Kinesiology		Anthropology of Play		Athletic Training		
	
Basic Instruction		Biomechanics		Coaching		Comparative/International		Curriculum		
	
Dance		History		Exercise Physiology		Philosophy		Sociology		Outdoor Education		
	
Literature		Pedagogy		Measurement & Evaluation		Motor Development		Motor Learning/Control		
		
Other															
					
Payment Information	
								
U.S. Faculty $ 80.00					
International Faculty $80.00 (includes mailing)					
Emeritus (all publications) $45.00					
Emeritus (Chronicle only) $15.00					
Graduate Student $30.00					
Concurrent AAKPE membership $20.00					
Tax Deductible Contribution to NAKPEHE					
Tax Deductible Contribution to Lecture Funds					
Tax Deductible Contribution to Diversity Fund					
Total Amount					
					
Canadian and other foreign members must use a money order or check imprinted “U.S. Funds”	
	
Please send your check with this printed form to:	
	
Ginny Overdorf	
51 Point View Pkwy, Wayne, NJ 07470.  	
Thank You for Joining NAKPEHE!