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Step One: Registration Form

Directions: To complete STEP ONE of the registration, carefully complete all of the information on the form below. Clicking the "Continue Registration" button below takes you to STEP TWO of the registration process. At a later date, you will have the opportunity to change information you complete below before submitting your final PEC Challenge Pin Order in March 2017.

** All fields are required unless otherwise noted! **

Name and School Information
First Name:
Last Name:
School/Organization Name:
State AHPERD Member: (If you are a Virginia, New York or Wisconsin state APHERD member, please check the box and enter your coupon code to receive the registration discount. Contact your states Executive Director if you do not know your code.)
Billing Information
(This is used for your credit card billing so make sure it is the address that your credit card statements are mailed to)
Street Address 1:
Street Address 2: (Not Required)
Street Address 3: (Not Required)
City:

Note: If you're not from the USA or Canada, select the choice "Not from US/Canada" under the State select box.
State: OR Province (Canadian Registrants Only!):
Zip Code:
Country:
Shipping Information
Click Here if your Shipping Address is the same as your Billing Address
(If shipping address is different, do not check the box and type in the correct shipping address)
Street Address 1:
Street Address 2: (Not Required)
Street Address 3: (Not Required)
City:

Note: If you're not from the USA or Canada, select the choice "Not from US/Canada" under the State select box.
State: OR Province (Canadian Registrants Only!):
Zip Code:
Country:
Phone Numbers
Only used if we need to contact you about the Challenge
Use (xxx) xxx-xxxx OR xxx-xxx-xxxx format if from USA.

School Phone: (include area code)
Home Phone: (Not Required, but HELPFUL!)

User Name and Password
Email Address (this will serve as your User Name)

You must have a valid and reliable email address that you check on a regular basis! Home or School email addresses are fine. We communicate with you via email so please make sure it is correct!

Type E-mail Address (type correctly!):

Type Same E-mail Address Again:
Password
Your password must be AT LEAST 5 characters, contain AT LEAST 1 digit and CANNOT be the SAME as your EMAIL ADDRESS.

Password:

Type Password Again:
Reminders

  • By clicking the "Continue Registration" button, you are confirming that you understand and agree to follow the guidelines and procedures that govern the PE Central Challenge.

Please click the "Continue Registration" Button only ONCE!

Takes you to Step 2 of the Registration Process

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