ArkAHPERD Membership, Convention, and SPARK Training Printable Registration Form

1. ArkAHPERD Convention - Embassy Suites
Little Rock - November 5-7, 2014
Pre-Registration DEADLINE October15, 2014
Name
Address
.
City State Zip
Email
- please print clearly –
Type: (check one) Amount
Professional Member ($165 after Oct 15)……. $150.00
Student Member ……($70 after Oct 15)…….. $ 60.00
Non Member ……………………………………….. $200.00
Guest of Member ……………………………….... $125.00
One-Day Registration ……………………………. $100.00
Convention Total:
Note: Fee includes Thursday’s Buffett dinner and Friday’s Award Luncheon
ArkAHPERD MEMBERSHIP APPLICATION
To receive the reduced convention fee above complete the following membership
information. You will receive notices and updates throughout the year. You will also
have opportunities to attend workshops within your District.
Type of Membership:
� Professional $40.00 � Full -Time Student $10.00
� JRFH/HFH Coordinator COMP � Lifetime $600.00
Major area of employment: (Check all that apply)
� Elementary � Middle � High School � College/University
National AAHPERD Member: YES___ NO____MEMBER #____________________
Membership Total:
SPARK Workshop Nov 5, 2014 [9-3:30]: (check one) Amount
With Convention Registration…….………… $35.00
Without Convention Registration…….……. $45.00
Workshop Total:
Page Total:
� Check Enclosed/Check Number: __________
� PO Enclosed/PO Number: __________
CHECKS PAYABLE TO: ArkAHPERD, P.O. Box 240, State University, AR 72467
Membership and Convention registration available online
www.arkahperd.org