Indiana High School Swimming Coaches Association 2003-04 Membership Form

Indiana High School Swimming Coaches Association
2003-2004 Membership Application and Fall Clinic Fee
-- PLEASE TYPE OR PRINT --

`Coach Name:`		`_________________________________`
`School:`		`______________________________________________`
`School Address:`		`______________________________________________`
`City, State Zip:`		`_____________________________ ____ ___________`
`School Phone:`		`(_____)_____-_________`
`School Fax:`		`(_____)_____-_________`
`Email Address:`		`_____________@___________________`
`Home Address:`		`______________________________________________`
`City, State Zip:`		`_____________________________ ____ ___________`
`Home Phone:`		`(_____)_____-_________`

		`Please Choose One of the Membership Plans`
`Indiana`		`High School Swimming Coaches Association`
`National`		`Interscholastic Swimming Coaches Association`
`American`		`Swimming Coaches Association`
`________`		`$15.00 IHSSCA Head Boys or Girls`
`________`		`$20.00 IHSSCA Head for Both`
`________`		`$10.00 IHSSCA Assistant or Diving Coach`
`________`		`$50.00 IHSSCA & NISCA Boys or Girls`
`________`		`$55.00 IHSSCA & NISCA for Both`
`________`		`$100.00 IHSSCA, NISCA & ASCA Boys or Girls`
`________`		`$105.00 IHSSCA, NISCA & ASCA for Both`
		`Fall Clinic Registration Fee`
		`Clarion Hotel Waterfront Plaza Oct. 2 & 3, 2003`
`________`		`$45.00 preregistration fee due before September 23`
`________`		`$55.00 at the door for members`
`________`		`$60 for nonmembers`

`$________`		`Total Fees Enclosed`

2003-2004 will be my ____ year as a Head Swimming Coach
2003-2004 will be my ____ year as an Assistant or Diving Coach
Please Mail Check or Money Order Made Payable to the IHSSCA to:

Back to IHSSCA Bart Braden
Franklin Central High School
6215 South Franklin Road
Indianapolis, IN. 46259