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Northland Chapter American College of Sports Medicine (NACSM) Membership Form

Name________________________________________________________________________
Address 1____________________________________________________________________
Address 2____________________________________________________________________
City__________________________St_____Zip______                      Phone______________
Degree sought or held______ Graduation year and advisor (students only)_________
Email_______________________________(please type or print clearly, all chapter communications are sent to this email address)

Membertype: (circle one)

Student($15)                     Professional/ACSM Fellow/Associate($35)

_____  Please include me in the NACSM Worksite Health Promotion Group Mailings and Activities

Candidates for "professional" regional chapter membership must possess a bachelor's, master's, terminal degree in health related areas such as medicine or physical therapy, physical education or exercise science. Professionals such as nurses currently working in a heath related field are also eligible for professional membership. Student members are required to be enrolled in a degree program that leads to conferring of a degree that would qualify a person for professional membership. Students must carry a minimum of a half time load at their institution. Associates are any persons not qualifying for Student or Professioal membership.

Why are you joining the NACSM?

Please read Code of Ethics (Use the <BACK> on your browser to get back to this page)

Signature_________________________________

By completing and submitting this form to NACSM, I affirm the statements made by me on this application are correct and that I meet the requirements for the membership category I have requested. I agree to conduct myself in accordance with the Code of Ethics. I understand that NACSM membership dues are not prorated. Accepted membership applications are not refundable or transferrable. Dues paid after 7-1-2008 will expire 1 year from end of month you join. A person joining on between July 1 and July 31, 2008 will be a member until July 31, 2009.

 

 


Send signed form with a check for amount indicated made out to NACSM to:
Northland ACSM
110 SPHC-UMD
1216 Ordean Court
Duluth MN 55812