South Carolina Athletic Coaches Association (SCACA) R...
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Transcript of South Carolina Athletic Coaches Association (SCACA) R...
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