NORTH DAKOTA INTERSCHOLASTIC ATHLETIC ADMINISTRAT0RS ASSOCIATION

AND

NATIONAL INTERSCHOLASTIC ATHLETIC ADMINISTRATORS ASSOCIATION

DUAL MEMBERSHIP 2017-2018

Please complete and return to:

Lorell Jungling

Executive Director

1205 4th Ave. NE

Mandan, North Dakota 58554

(DO NOT MAIL IN YOUR DUES TO NIAAA)

First Name______M.I. ____Last Name______Suffix:____ (Jr., III, etc)

(As it appears on your driver’s license)

School or Organization: ______Title: ______No. Years AD (count current year) ______

Office Address:______District:_____ Class:______

City: ______State: ______Zip: ______

Office Phone: (______)______Home Phone: (_____)______Preferred Mailing Address: Home ___School ____

Fax: (______)______E-Mail Address:______

For NIAAA insurance purposes, the following information must be provided:

SSN: ______Birth date: ____-_____-______Male ___ Female ___ Smoker – Yes _____ No ______

Home Address:______

City: ______State: ______Zip: ______

The NIAAA studies diversity among our membership. In this regard, a database has been instituted to collect this information from our membership. We appreciate your completion of this section so we may better serve our membership>

______Caucasian ______Latino ______American Indian ______Asian

______Pacific Islander ______African American ______Multi-Cultural ______Alaskan Native

If none of the above codes seem appropriate, please indicate your background: ______

DUAL MEMBERSHIP (NDIAAA/NIAAA)--$125.00

(Check payable to: NDIAAA) (Date Rcvd. ______

NDIAAA/NIAAA MEMBERSHIP INFORMATION

If you are involved in administrating interscholastic athletics at the high school, middle school or junior high level then you should join these professional organizations.

The NIAAA is a national professional organization and the NDIAAA is the state professional organization administered by, and for, athletic administrators for the purpose of:

·  Promoting professional growth and image of interscholastic athletic administrators

·  Promoting the development and prestige of state athletic administrators organizations, which will contribute, in cooperation with state high school associations, to the interscholastic athletic program of each state

·  Providing an efficient system for exchange of ideas between the NFHS and state athletic directors organizations and individual athletic administrators

·  Preserving an educational nature of interscholastic athletics and the place of these programs in the curricula of schools

MEMBERSHIP BENEFITS

·  The IAA, a quarterly professional journal written by and for athletic administrators

·  The NDIAAA website access

·  $1,000,000 liability insurance while performing the duties of an athletic administrator (an additional $1,000,000 for those who have taken LTP 501 and LTP 504)

·  $2500 term life insurance

·  Opportunity to attend the NDIAAA Fall Workshop & Spring Conference

·  Discount on registration fees for the NFHS National Conference for high school directors of athletics

·  Opportunities to serve on national committees and state committees and board of directors.

·  Opportunity to submit student scholarship applications for students from your school.

·  Opportunity to purchase long-term health care at significantly discounted prices.

·  Registration Fee of only $1.00 for “From the Gym to the Jury” online newsletter. Reg. $39.95 for non-member.