OSSCA Dues Registration 2016

Head Coaches must fill out this Form. If you are registering an Assistant Coach include a form for them as well.
Name: _________________________________________

NSCAA Member #_____________

Address: _______________________________________
City: ________________________________

Zip: ________

Cell Phone:(_______)___________

E-Mail Address: _____________________________________

PLEASE CHECK the following information: Check OHSAA website for proper classification. (www.ohssa.org)
Boys ___

Girls ___

Head Coach ___

Division I ___

Division II ___

Division III ___

Assistant Coach ___

Are you a new coach to the association: ___ Yes ___ No

Are you a coach who has changed schools: ___ Yes ___ No
School: _________________________________________
School Address: _________________________________
City: _________________________

Zip: __________

Athletic Director: ____________________________________

Phone: (_______)___________________
Phone: (_______)___________________

Athletic Directors E-mail: _______________________________________________

District: Please check the appropriate District for your school
___ Akron

___ Central

___ Cleveland

___ Miami Valley

_X_ North Central

___ Northwest

___ Southeast

___ Southwest

___ Youngstown

___ East

Local Dues:

$ 25.00 (Head Coach only)

State Dues:

$20.00 (Head coaches only, ASST. COACHES-FREE FOR STATE DUES)

National Dues:

$55.00 (Head Coach - optional for assistant coaches)

TOTAL AMOUNT:

$ 100.00 (Head Coach Total)

Local Dues (Asst. Coach):

$ 10.00_ (Add Asst Coach to be eligible for District Awards)

Revised Total with Asst:

$ 110.00 (if applicable)

PLEASE MAIL YOUR DUES TO YOUR DISTRICT REP BY SEPTEMBER 1, 2015.

Make Checks To:
NCOSSCA
Mail To:
Chris Laux 6115 Clever Rd Bellville, OH 44813