Membership Application

Complete the form below. Press the <TAB> key to move from field to field. When you have finished, recheck your typing before clicking the SUBMIT button.  Thank you for your affirmation toward professional growth.

First Name
 Last Name
 Middle Initial
Street Address
City
 State
 Zip Code
Home Phone
School/Organization/Agency
 Professional County
Work Phone
 FAX
 E-mail
Student Graduation Date
   College/University
Select your membership type by clicking on the drop down box and highlighting your membership.

Add any comments below:

Check your area(s) of interest from the choices below:

Adapted Activities
Aquatics
Health
Physical Education
Recreation
Dance
Men's Athletics
Women's Athletics
Sport Management
Choose your Credit Card:  VISA MasterCard

Name as it appears on card

Card Number

Expiration Date mm/yyyy

 

Please recheck all the fields prior to submitting.

Click the Submit button
to send in your membership application.

Print the response screen which will appear immediately following your submission as your receipt

Thanks