PART A: SHAPE Colorado MEMBERSHIP (Membership dues are for one year from the date issued.)

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1 Quick and Easy Online Registration at Or use the form below 2018 SHAPE Colorado Convention Registration Radisson Hotel Denver Southeast in Aurora, Oct. 4 th -6th, 2018 Complete the form, make a copy for yourself and mail with payment to the address on page 3. Registration and payment for the DISCOUNT Early Bird registration, online or postmarked and paid for by September 6, All registrations must be completed, paid for and postmarked by September 27, 2018 to include meals. Please print Name: Mailing/Home Address: Street City State Zip Phone (h): Phone (w): School District: School/Organization: Position: Level you Teach : PART A: SHAPE Colorado MEMBERSHIP (Membership dues are for one year from the date issued.) TYPE DESCRIPTION PRICE List price for all that apply Professional Persons professionally engaged in one or more of the areas of HPERD. $60 3 Year Professional Three Year Professional membership, 10% discount. $162 5 Year Professional Five Year Professional membership, 15% discount. $255 Student Undergraduate/Graduate First Year Professional Second Year Professional Retired Full-time students who are not teaching, who are preparing for a degree in the various areas of HPERD. If you were a COAHPERD/SHAPE Colorado student member, and this is your first year as a teacher, you may sign up for the.00 First Year Professional rate. Must have been a First Year Professional. If you were a student, then a first year professional SHAPE Colorado member, you may sign up for the Second Year Professional price of $ Retired professionals who want to continue advocating for HPERD. To qualify for this, a person must have been a professional SHAPE Colorado member in good standing for five continuous years prior to retirement or disability, and has reached age 55, and has retired from full-time professional employment in the field of HPERD. $10 $45 $0

2 Honorary Life Member Past President of COAHPERD/SHAPE Colorado. $0 Host of an AHA Event A professional who has hosted a Jump/Hoops for Heart Event in the school year. (register as a Professional member) $0 Quick and Easy Online Registration at Or use this 2018 Convention Registration form Part B: Convention Registration Circle your price TYPE Thursday ONLY FRIDAY and SATURDAY ONE DAY PASS You must be a current SHAPE Colorado member to attend these sessions. DISCOUNT Early Bird By Sept. 6 Meals included (Fri./Sat. lunch, Fri. Awards dinner) GENERAL REG. Sept. 7 Sept. 27 Meals included (Fri./Sat. lunch, Fri. Awards dinner) LATE REG. Sept. 28 Onsite No Meals Included Meals included up to Sept 27 (Circle - Fri. Lunch & Award Dinner or Sat. Lunch) Professional Student, Retiree and Life Member Insert fees listed below. Prices are the same for all membership types. $165 $190 $190 $110 $100 $130 $130 $80 Non-members $ $185 Go to for information on how to apply for a student scholarship PART C: THURSDAY PRE-CONVENTION WORKSHOPS You must be a current SHAPE Colorado member to attend the workshops. You may register for just the Thursday workshops. PRICE TIME NAME OF WORKSHOP Details for workshops are online at: List price for all that apply DANCEPL3Y KIDS for School Teachers Express Training Speakers: Brooke Yantzi DanceSyndrome: Creative Development of Leadership and Life Skills Speakers: DanceSyndrome (Jen Blackwell and Beth Fox)

3 Purposeful Physical Education: Creating Standards-Based Experiences for Your Students Speakers: Joey Feith Let s Have Fun in Health Class Today Speakers: Melanie Lynch 4:00pm These Are a Few of My Favorite (PE) Things! Speakers: Ron Trainum Free 4:00pm 4:00pm 4pm 4pm Net Generation Tennis and School; The Perfect Match! Speakers: USTA Ninja Training: How Understanding ESSA Can Further Your Health and Physical Education Efforts Speakers: Amy Dillon and Amy Dyett Emerging Leaders Workshop (Formally Future Professionals) Speakers: TBD S.I.C.K. Beats to Move Your Feet Speakers: Scott Williams Optional Donation: Cindy Young Scholarship Fund Please help emerging leaders receive scholarships toward convention registration by donating to this line item. A - Membership Dues B - Convention Registration (meals are provided with registration fees) C Pre-Convention Workshop Fees Cindy Young Scholarship Fund (Any amount appreciated) TOTAL REGISTRATION FEE

4 Complete and mail this form with payment (check made out to SHAPE Colorado) Convention Registration Mail to: Terry Jones 4107 South Rome St. Aurora, CO This form must be postmarked and full payment made by September 6th, 2018 for Early Bird registration or September 27th, 2018 or your registration will be void. Cancellation Policy: Cancellation notifications must be in writing to: by September 27, A $25 processing fee is charged for all cancellations. Refunds will not be issued after September 27, Refunds will not be issued due to inclement weather unless the convention is canceled. Hotel Registration: Contact the hotel directly by September 19, 2018 for SHAPE Colorado discount of $92 + tax discount. Questions about registration? Contact Terry Jones at terry@shapeco.org Personal Check # or School District Check # Cash Amount _ Credit card company (circle): (Visa or Master Card Only) Card Number: Expiration date: Security Code: Name and address on card if different from registrant information: Name: Address: street city zip Meals are provided as part of your registration fee (if registration is received before September 27, 2018) Please indicate your selection with an X, or an NA if you will not be eating. Thursday- No Meals Provided Friday Lunch Baked Potato Bar with Vegetarian and Gluten Free options Friday Award Dinner- Select One Taste of Italy Buffet with Vegetarian and Gluten Free options Saturday Lunch

5 Classic American Buffet with Chicken/Beef and Vegetarian and Gluten Free options Please list Dietary Restrictions: Yes or NO Please send an to my administrator stating: On behalf of SHAPE Colorado, we would like to thank you for your support of quality health and physical education by making it possible for your districts PE and Health professionals to attend SHAPE Colorado Conference. We also want to confirm that by attending this professional development opportunity, they are showing leadership and commitment towards quality health and physical education. Administrator Name School Board President: Name Professional Questions: Please mark the boxes that apply to you. Advocacy: Do you advocate for health and physical education in your district and would like to know what is being done at the state and national level? Convention: Have you attended a SHAPE Colorado Convention within the last 3 years? Professional Development: Are you interested in getting updates about different Professional Development opportunities available throughout the school year? Emerging Leaders: Have you been teaching for less than 3 years or are new to teaching health and physical education? (Office use only) Received by: Date Received Date Entered

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