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NEAEP Membership Application
Starting January 2002, the NEAEP membership year is January to December. Individuals applying for the first time for NEAEP membership should complete a Membership Application, indicate the type of membership desired, and submit a current Curriculum Vitae to the NEAEP State Office. A check made payable to the Nebraska Association of Exercise Physiologists (or NEAEP) MUST accompany all membership applications. Individuals applying for student membership must be a bonafide student (i.e., in the process of completing a degree in exercise physiology/science). Students are encouraged to submit their permanent home address for the NEAEP Directory of Membership.
Note: A "renewal letter" will be sent to NEAEP members by the end of January of each new year. In this way, the cost to belong to NEAEP will be separate from the cost to attend the Annual State Meeting.
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If you wish to join NEAEP, print the following application (or request a copy from the NEAEP State Office) and send it with your Curriculum Vitae to:
NEAEP
16 W. 32nd St.
Kearney, NE 68847
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NEAEP MEMBERSHIP APPLICATION
Biographic Information
Full Name (please print) (PhD/MS/BS/none)circle one
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Phone: (work)
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FAX: email:
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Address:
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Application Fee: Identify one of the following and, where appropriate, enclose a check payable to NEAEP:
PROFESSONAL MEMBER:
CERTIFIED PROFESSIONAL MEMBER:
EMERITUS MEMBER (NO FEE)
HONORARY MEMBER (NO FEE)
STUDENT MEMBER:
FELLOW MEMBER:
Educational Background
Undergraduate
Institution:
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City/State
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Dates Attended /Completed
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Degree /Emphasis
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Graduate: (MS, MA, etc)
Institution
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City/State
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Dates Attended/Completed
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Degree /Emphasis
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Graduate: (PhD, MD, etc)
Institution
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City/State
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Dates Attended /Completed
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Degree /Emphasis
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Agreement
I hereby apply for membership in the Nebraska Association of Exercise Physiologists, and agree to abide by its Charter and objectives. I understand that NAEP may make inquiries about academic credentials for the purpose of verifying information in this application. I pledge myself to standards of ethical practice and conduct as specified in the ASEP Code of Ethics.
I certify that the above information is accurate, and I understand that inaccurate information can invalidate my application.
Signature /Date
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