MHSSCA Membership & Clinic Form 2023-2024

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Please fill out the form completely by January 5, 2024. Dues can be mailed (if you want to use a credit card, fill out form on the website instead of this one):

MHSSCA

PO Box 803

Grand Blanc, MI 48439

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メールアドレス *

High School *

Division *

Retired or not a HS Coach

Your level of coaching *

Head Varsity

Assistant Varsity

Head JV

Assistant JV

Head JV B

Assistant JV B

Head Freshman

Assistant Freshman

Retired or Not a HS Coach

First name *

Last name *

Email Address *

Complete Mailing Address (house number street name, city, zip code) *

Phone number *

Were you a MHSSCA member in 2023? *

Yes

First & last name of coaches attending clinic with you if they are NOT filling out their own form.

Varsity Level Head Coach ONLY (no assistants, JV, JV b, or freshmen records)

Varsity Coaching Record (wins-losses)

Years of being a MHSSCA member. Reply with a number only, anyone new will enter 0. *

Varsity coaches: if you are attending the clinic, how many coaches from your program will attend the banquet? (respond with a number, 0 means no one is attending the banquet) *

more than 10

Jobs I'm interested in volunteering for

District Representative

Regional Representative

Rankings

Hall of Fame

Clinic

Scholarship

Ethics

All Star Game (for seniors)

Payments: please select which one you will do by January 5th for clinic with membership (remember to MAIL in your payment; cc is a different form on the website) PAYING ON TIME has a lesser fee. Address is at the top of this form. *

Membership & Clinic $150/each, $130/each for early bird paid by January 5th (for all levels of coaches)

Membership ONLY (no clinic) $90/each (for all levels of coaches), $70 for early bird before April 15th

Membership & Clinic for 5-8 coaches $500 (by January 5th)

Membership & Clinic for more than 8 coaches $500 plus $130 for each coach after 8th (early bird by Jan. 5th)

Clinic attendee only: for middle school, college, travel ball, or youth coaches that are not a high school coach or assistant $80

RETIRED Coaches ONLY

Lifetime Membership $100

Lifetime Members Clinic Fee $30

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I understand that for coaching milestone awards (years of MHSSCA membership & varisty record), I need to contact Dan Schaser by December 15, 2023 coach.dan.schaser@gmail.com

(see MHSSCA website for email & more information)

YES, I will email Dan before December 15th for the awards I've achieved

必須

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