Page 24 - CHSCA Fall-Winter Magazine 2020-2021
P. 24

  CONNECTICUT HIGH SCHOOL COACHES ASSOCIATION
INDIVIDUAL MEMBERSHIP APPLICATION
PERSONAL INFORMATION:
Name:___________________________________________ School: ______________________________ Preferred Email Address: _________________________________________________________________ Mailing Address:________________________________________________________________________ City/Town:__________________________________________________ Zip:______________________ Preferred Telephone #: ___________________________________________________________________ Cell Telephone #: _______________________________________________________________________ I hold a 5 Year Renewable Coaching Permit: q Yes q No Expiration Date:___________________ I hold an Emergency Coaching Permit: q Yes q No Expiration Date:___________________
PROFESSIONAL INFORMATION:
 q Head Coach q Assistant Coach
Sport: ____________________________________
Sport: ____________________________________
Sport: ____________________________________
Note: Retired coach applicants must have 15 years of coaching and 60 yrs. of age to be considered.
q Volunteer Coach q Retired Coach School: ____________________________________ School: ____________________________________ School: ____________________________________
By signing this application, I certify that the above information is valid and truthful.
Applicant’s Printed Name:________________________________________________________________ Applicant’s Signature: ____________________________________________ Date: ____/ _____/_____
A payment of $30.00 per membership, per year, must accompany this application. Make payable to CHSCA. **Money order, cashier’s check, business, school or personal checks accepted. There will be a fee of $25.00 for returned payments. The membership year runs from August 1 to July 31.
For school group memberships information please contact: CHSCA Membership Director – chsca63@gmail.com
Return application to:
CHSCA Membership Director, 30 Realty Drive, Cheshire, CT 06410
 PAGE 24 • CONNECTICUT COACH • ISSUE 1 – 2020-2021

















































































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