Indiana High School Swimming Coaches Association
2005-2006 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
________
 $20.00 IHSSCA Head Boys or Girls
________
 $25.00 IHSSCA Head for Both
________
 $15.00 IHSSCA Assistant or Diving Coach
________
 $55.00 IHSSCA & NISCA Boys or Girls
________
 $60.00 IHSSCA & NISCA for Both
________
$110.00 IHSSCA, NISCA & ASCA Boys or Girls
________
$115.00 IHSSCA, NISCA & ASCA for Both
 
  
  


Fall Clinic Registration Fee
 
Clarion Hotel Waterfront Plaza October 6 & 7, 2005
2930 Waterfront Parkway West Dr. 
Indianapolis, Indiana 46214     Phone: (317) 299-8400  Fax: (317) 299-9257
________
  $60.00 Fee (includes lunch on Thursday)
 
  
  
$________
Total Fees Enclosed
2005-2006 will be my ____ year as a Head Swimming Coach
2005-2006 will be my ____ year as an Assistant or Diving Coach
Please mail check or money order made payable to the IHSSCA to:
Bart Braden
Franklin Central High School
6215 South Franklin Road
Indianapolis, IN.  46259
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