Missouri State High School Soccer Coaches Association
2012-2013 Membership Application
Name:
School:
School email:
If you are renewing your membership from the prior year, you need only submit changes to your address or phone information.
School address:
School phone:
Home address:
Job title:
.
2012-2013 MSHSSCA dues, paid BEFORE September 15: 2012-2013 MSHSSCA dues ONLY, paid AFTER September 15: Interested in joining the NSCAA as well? MSHSSCA members can join the NSCAA and receive a $15 discount off their membership! When your MSHSSCA membership application and dues are received, you will be sent a confirmation email that includes a discount code to use when you register at nscaa.com.
Would you like to make a donation to the Coaches Support Fund? Amount: $
Donations are used to assist our fellow coaches in their time of need. Please visit http://www.mosoccercoach.com/coachessupport.html
Total amount due: $
Number and street
If "other" please indicate:
Before submitting your application, please be sure that ALL fields are completed (except address and phone if no changes). We cannot process your membership if any fields are left blank. Thank you!
Or you may send a check made payable to MSHSSCA to:
Chris Miller
President, MSHSCCA
4008 Compton Rd.
Columbia, MO 65203
Note that membership applications will be processed once payment has been received.
We accept PayPal! After visiting PayPal, please be sure to return to this page and submit your membership application!
City, state, zip
Number and street
City, state, zip
