CHSCA: Coach-Individual Membership Application

2021-2022 Membership Year

Personal Information

* Indicates required field

Name *

First

Last

School: *

Preferred Email Address *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Telephone *

Cell Phone *

I hold a 5 Yr. Renewable Coaching Permit? *

Yes No

Expiration Date: *

I hold an Emergency Coaching Permit? *

Yes No

Professional Information (Select all that apply) *

Expiration Date *

Sport: *

School *

Sport *

School *

Sport *

School *

Note: Retired coach applicants must have 20 years of coaching and be at least 60 years of age to be considered.

By entering your full name, you certify that the above information is valid and truthful.

Applicants Full Name *

Date *

Online payment of $30.00 plus processing fee of $1.50 per membership-per year, must be submitted through the below payment link. Once you click "submit" you will be redirected to our online payment page. All membership cards will be mailed from the CHSCA office upon receipt of your registration and online payment.

Submit