OAHPERD

Full Name

School/Agency

Address City State Zip

Home Phone Bus. Phone Cell Phone

Email Fax

Professional Interest Areas (check all that apply)

Adapted Dance Health, Physical Education Athletics Administration

Health Recreation Other

If Other, please list

Teaching/Employment Level

Elementary Secondary Junior College College/University Other

If Other, please list

Geographical Area

Metro (Canadian, Cleveland, Oklahoma Counties)

SW (South of I-40 and West of I-35)

SE (South of I-40 and East of I-35)

NE (North of I-40 and East of I-35)

NW (North of I-40 and West of I-35)

Membership Dues

Professional Membership $35

Student Membership $15

Retired (not 62 years of age) $15

Emeritus (Professional Member 25 years, retired, min. 62 years of age) $0

Pre-Convention Workshops

Check one or more of the following you plan to attend. Note: Pre-convention workshops are included in your registration.

Physical Education Curriculum Analysis Tool
Coaches Workshop
Early Childhood: "Cat Paws"
Kid Shield: Self Defense

Convention Fees

Pre-Registration Deadline

(Insert date here)

Make Checks Payable to OAHPERD & Mail to:

Mark L. Giese

Health and Kinesiology

Northeastern State University

603 N. Grand Ave.

Tahlequah, OK 74464-2302