Convention Information Registration

Member # (leave blank if you don't know)

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

MAHPERD uses your email address for MAHPERD communications only. We do not share our database with any businesses or organizations.

Email(Required)

Home Phone

Cell Phone

School/Business(Required)

City/Town(Required)

Professional Responsibilities(Required)

Teacher

Coach

City-Town Director

Dept Head

Other

Field(Required)

Physical Education

Health

Adapted Physical Education

Dance

Recreation

Other

Level(Required)

Elementary

Middle

High School

College

Other

(All convention attendees must be 2023-2024 MAHPERD members)

Early Registration Fees (Early registration deadline is Friday, October 27th)

Professional 1 Day: $150.00
Professional Both Days: $175.00
Student or Retired 1 or 2 Days: $60.00
Non-Member Registration for 1 or 2 Days:
$350.00

Registration(Required)

Membership(Required)

Purchase Order
If you are paying with a scanned or digital purchase order you can attach it to this form by clicking Upload PO.

If you are paying with a credit/debit card select Pay Online (Credit Card/PayPal). At the Payment Method option, click and select Credit Card and fill in your credit card information. Click Submit to complete your registration/membership application/renewal.

Select Payment(Required)

Pay Online (Credit Card/PayPal)

Upload PO

Attach Purchase Order

Max. file size: 256 MB.

Full Time Student
Professionals do not qualify for student status.

In order to qualify as a student member you have to:

1. Be a full time student enrolled in an undergraduate or graduate degree program at a college or university. Professionals do not qualify as a full time student.

2. Currently registered for a minimum of 12 credits a semester.

Documentation confirming your degree program and enrollment status from your college or university may be requested.

Select college or university(Required)

Major

Graduation Date

Comment

Total

Choose Payment Method (PayPal Or Credit Card)

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Please review all the information that you've entered. Your registration will not be finalized until you complete the payment portion of the registration process either by attaching a purchase order or paying by credit/debit card.

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Massachusetts association for health, physical education, recreation and dance Inc.

94th Annual MAHPERD STATE CONVENTION

MAHPERD Convention 2023 Registration