GAHPERD Membership Form

Thank you for your interest in joining GAHPERD! Please complete this form. Next, you will be asked to submit payment with a credit card through PayPal.

Are you creating a new membership today or renewing a current membership? *

New

Renewal

Membership Classification and Dues (select one): *

Professional (includes grad students) 1 Year $35.00

Professional (includes grad students) 2 Year $55.00

Professional (includes grad students) 3 Year $75.00

Retired 1 Year $25.00

Future Professional (undergraduate student) 1 Year $15.00

First Name *

Last Name *

I am a: *

Male

Female

Preferred Mailing Address *

Address Line 2

City *

State *

Zip Code *

County of Residence *

County of Employment *

School/Organization/Employer *

Home Phone *

Work Phone

Fax Number

Preferred Email Address *

Alternate Email Address

Employment Classification *

Other Memberships:

SHAPE America Member? *

Yes

No

If "Yes", SHAPE America member number:

GAE Member? *

Yes

No

If "Yes", GAE Member number:

Areas of Interest:

Division (select one): *

Dance

General

Health

Physical Education

Sections (select two): *

Elementary	Middle School
Secondary	Two-Year College
College/University	City/County/District Administrator
Other Other