south carolina athletic coaches association (scaca) r...
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South Carolina
Athletic Coaches Association (SCACA)
R. Shell Dula sccoaches.org Post Office Box 50028
Executive Director Greenwood, SC 29649
Phone (864) 388-2479
Fax (864) 388-2478
Membership #______________ _______Renewal _______ New
Name: ______________________________________________________________ Last 4 digits of SSN: ______________
Home address: _______________________________________________________ Home phone #: _________________
Email address:________________________________________________________Cell Phone # ____________________
*School name: _______________________________________________________________________________________
School address: ______________________________________________________ Phone: _________________________
*Circle school name if changed since previous year.
1. Number of years active coach in SC public schools: _____________________________________________________
2. Number of years member of SCACA: ________________________________________________________________
3. Current sport(s) serving as Head Coach: ______________________________________________________________
4. Current sport(s) serving as Assistant Coach: __________________________________________________________
5. Athletic Director: ____Yes ____No
6. Full or part-time employee of the school system: ____Part-time _____Full-time
CHECK the amount due: _____ $40.00 (Prior to July 10, 2016) _____ $50.00 (After July 10, 2016)
ONLY MEMBERS OF SCACA PERMITTED TO ATTEND CLINIC.
Make checks payable to SCACA and mail, along with the completed form, to:
Shell Dula, PO Box 50028, Greenwood, SC 29649.
Athletic Trainers (AT)-$5.00 Cheerleading (CL)-$7.00 Soccer (SO)-$8.00 Track/Cross Country (TR)-$10.00
Baseball (BE)-$10.00 Football (FB)-$10.00 Swim (SW)-$8.00 Strength Coaches (SC)-$5.00
Basketball (BT)-$10.00 Golf (G)-$8.00 Tennis (TE)-$10.00 Wrestling (WR)-$5.00
CAWS -$10.00 Lacrosse (LA)-$7.00
TOTAL AMOUNT DUE (SCACA DUES + AUXILIARY ORGANIZATION MEMBERSHIPS): $_________
North-South Football Ticket(s)__________@ $5.00 each = ______________
FOR OFFICE USE ONLY:
Member Name: _______________________________________________________________ Member #: ______________
Received by: ___________________________ Date: ________________________ Amount PAID: $____________________
Complete 1-6
Auxiliary Organization Memberships (CIRCLE ALL THAT APPLY)
SCACA Dues
North/South Football