Membership Form
PLEASE COMPLETE THE FORM BELOW AND SUBMIT IT. THEN MAIL YOUR CHECK TO: BRIAN JILLINGS HICKORY HIGH SCHOOL 1234 3RD STREET NE HICKORY, NC 28601
SCHOOL NAME:
NCSCA Region: 1 2 3 4 5 6 7 8 9 10 11 School Classification: Private Public 1A Public 2A Public 3A Public 4A
SCHOOL ADDRESS: CITY: STATE: ZIP:
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NAME of Boys Head Coach:
HOME ADDRESS: CITY: STATE: ZIP:
HOME PHONE #: SCHOOL/WORK PHONE #:
CELL PHONE #: FAX #:
E-MAIL ADDRESS: OR
NAME OF Boys ASSISTANT COACHES:
WHAT IS YOUR NSCAA MEMBERSHIP NUMBER?
--------------------------------------------------------------------------------------------------------------------------------------------------------------------If the Girls coach is the same as the Boys Coach - put "Same" in the Name box and proceed to the next section.
NAME of Girls Head Coach:
NAME OF Girls ASSISTANT COACHES:
------------------------------------------------------------------------------------------------------------------------------------------------------------------- WHAT PROGRAM(S) & ORGANIZATIONS DO YOU WISH TO REGISTER/JOIN? CHOOSE ONE ONLY.
NCSCA ONLY/BOYS SEASON ONLY $40 NCSCA ONLY/GIRLS SEASON ONLY $40 NCSCA ONLY & BOTH BOYS & GIRLS SEASONS $70 NCSCA & NSCAA/BOYS SEASON ONLY $100 NCSCA & NSCAA/GIRLS SEASON ONLY $100 NCSCA & NSCAA/BOYS & GIRLS SEASONS $130
MAKE CHECKS PAYABLE TO THE "NCSCA"
If you are a FIRST TIME member of the NCSCA, your membership is FREE for your FIRST SEASON as long as you are SPONSORED by a current NCSCA Member. Please fill out this section if you have a Sponsor.
Sponsor's Name:
School Name:
MAKE CHECKS PAYABLE TO THE "NCSCA" AND SEND IT TO: BRIAN JILLINGS HICKORY HIGH SCHOOL 1234 3RD STREET NE HICKORY, NC 28601
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