Welcome to Tahperd, the global organization for any professionals involved in physical education, recreation and dance. As a member of our organization, you have access to countless resources that can help further your career and promote the importance of physical activity. To ensure that all members reap the benefits Tahperd has to offer, we ask that you please fill out this Membership Form as soon as possible so we can set up your individualized membership package. With this form, you will be supporting active lifestyle choices while contributing to a growing community of like-minded individuals who prioritize health and wellbeing!
| Question | Answer |
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| Form Name | Tahperd Membership Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | tapherd membership form, SHAC, attendee, Newsletters |
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MEMBERSHIP APPLICATION |
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7910 Cameron Road | Austin, Texas 78754 |
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Ph: (512) |
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Name: |
Work Phone Number: |
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ISD/University/Other Employer: |
Home Phone Number: |
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Campus/School Name: |
Cell Phone Number: |
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Home Mailing Address: |
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City/State/Zip: |
Ethnicity: (For Grant Purposes) |
Gender: (For Grant Purposes) |
If a Previous TAHPERD Member: |
Birth Year: (For Grant Purposes) |
Teacher Certification Year: |
Member ID#: |
Expiration Date: |
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PROFESSIONAL MEMBERS ONLY
INSTRUCTIONS:Pleaseusethecorrespondingnumbersinthecolumnsbelowtoselectthebestdescriptionineachcategory.
PRIMARY Job Description: |
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SECONDARYInterest: |
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Classification: |
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Highest Degree Completed: |
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Primary Interest: |
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PRIMARY Job Description: |
Classification: |
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PRIMARY Interest: |
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(choose one) |
(choose one) |
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(choose one) |
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1. |
Teacher/Professor |
1. Elementary |
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Physical Education |
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2. |
AthleticCoach |
2. Middle School |
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2. |
Athletics |
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3. |
AthleticTrainer/SportsMedicine |
3. Secondary |
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3. |
Research |
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4. |
Administrator |
4. Community/Junior College |
4. |
Dance |
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5. |
Teacher’s Aide |
5. College/University |
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5. |
Recreation |
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6. |
Recreation/Parks Staff |
6. Government Office/Agency |
6. |
Health |
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7. |
Hospital/Clinic Staff |
7. Recreation/Parks |
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7. |
Adapted/Special Programs |
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8. |
Private/VolunteerAgency |
8. Other |
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8. |
Administration |
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9. |
Corporate/Private Fitness |
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9. |
Other |
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10. Other |
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SECONDARY Interest: |
Please Check the Boxes that Apply: |
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(choose one) |
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1. |
Physical Education |
My school has a School Health Advisory Council (SHAC) |
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2. |
Athletics |
My SHAC meets on a regular basis |
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3. |
Research |
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I coordinate a Hoops for Heart event |
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4. |
Dance |
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I coordinate a Jump Rope for Heart event |
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5. |
Recreation |
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6. |
Health |
I am a Physical Education Coordinator or similar |
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7. |
Adapted/Special Programs |
Administrator |
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8. |
Administration |
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I am a college majors club sponsor |
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9. |
Other |
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Highest Degree
Completed:
1.Bachelors
2.Masters
3.Doctorate
MEMBERSHIP OPTIONS (CHECK ONE) |
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❏Professional Membership (One Year) |
$ 60 |
(Certified Teachers and Professionals) |
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❏5 yr. Professional Membership |
$ 261 |
❏AssociateMembership |
$ 50 |
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$ 60 |
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❏Student Membership |
$ 20 |
(Student MUST be a |
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❏Retired Membership |
$ 20 |
(Contact TAHPERD State Office for eligibility criteria.) |
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Payment Information
Check enclosed payable to: TAHPERD
Credit Card#: ____________________ Exp. Date:_____
Signature:__________________________________
If Paying with a School Purchase Order
Please Read the Following:
Individual application forms for each attendee must be attached to all school purchase orders. All checks sent to the State Office by a school district must attach copies of eachattendee’s application form.
Original/CopyoforiginalPORequired.
RequisitionortravelvouchersforP.O.’sareNOTaccepteddocumentation.
BillingAddressMUSTbeonthepurchaseorder.
FOR TAHPERD OFFICE USE ONLY:
CC AP#______________________ PO # ____________________