Iowa IAHPERD

2017 Fall IAHPERD Workshop Registration Form

The IAHPERD Fall Workshop will be held at Valley High School in Des Moines, IA on Sunday, October 15th. If you are registered before October 6, the cost is $15. Walk-up registration is $20.

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address (that you would like to be contacted by) *

Please select your level. *

Student

Professional

Retired

Students - College/University that you are attending

Professionals - Please select your teaching level.

Professionals - School District you are affiliated with. (Adair- Casey to Prairie Valley Community School Districts)

Professionals - School District you are affiliated with. (Red Oak to Woodward-Granger Community Schools)

What do you teach?

Round table discussion ideas *

Workshop Registration-- Please note... no refunds will be given. *

IAHPERD Member ($15.00 before 10/6/2017)

Non- IAHPERD Member ($25.00 before 10/6/2017)

Walk up registration is $20.00

Current Total:

$0.00

Required *

I have made sure that all information is current and correct.

Buena Vista University	Central College	Clarke College
Dordt College	Iowa Wesleyan University	Graceland University
Loras College	Northwestern College	Saint Ambrose University
Simpson College	University of Dubuque	University of Northern Iowa
Wartburg College	William Penn University	Other Other

Elementary	Middle School	High School	K-12
College/University	Community Agency	Other

Physical Education	Health	Adaptive Physical Education
College Level	Other