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:              School Classification: 

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:         

HOME ADDRESS:          CITY:      STATE:     ZIP: 

HOME PHONE #:                 SCHOOL/WORK PHONE #: 

CELL PHONE #:                   FAX #: 

E-MAIL ADDRESS:    OR 

NAME OF Girls ASSISTANT COACHES:     

WHAT IS YOUR NSCAA MEMBERSHIP NUMBER?      

-------------------------------------------------------------------------------------------------------------------------------------------------------------------    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"

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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:     

HOME PHONE #:                 SCHOOL/WORK PHONE #: 

CELL PHONE #:                   FAX #: 

E-MAIL ADDRESS:    OR 

                                                                                    

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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