OSSCA Dues Registration 2017

Head Coaches must fill out. If you are registering an Assistant Coach include a separate form for the Assistant.

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 ___ Division I ___ Division II ___ Division III ___

Head Coach ___ 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: __________ Phone: (_______)___________________

Athletic Director: ____________________________________ Phone: (_______)___________________

Athletic Directors E-mail: _______________________________________________

District: Please check the appropriate District for your school.

___ Akron ___ Central ___ Cleveland ___ East

___ Miami Valley _X_ North Central ___ Northwest

___ Southeast ___ Southwest ___ Youngstown

Local Dues: $ 25.00 (Head Coach only)

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

National Dues: $60.00 (Head Coach - optional for assistant coaches)

TOTAL AMOUNT: $ 105.00 (Head Coach Total)

Local Dues (Asst. Coach): $ 15.00_ (Add Asst Coach to be eligible for District Awards)

Revised Total with Asst: $ 120.00 (if applicable)

PLEASE MAIL YOUR DUES TO YOUR DISTRICT REP BY SEPTEMBER 1, 2017.

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