Presbyterian Coach Network Membership Form

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Please fill out this form if you are a new member or updating your existing membership information.

(See the PCN Coach Referral Page to view your current listing.)

Membership Type *

Full Member (Certified Coach - Membership = $50)

Associate Member (Seeking Certification - Membership free first year, then $50)

If you would like to pay your membership fee now, please CLICK HERE

or send check to:

First Presbyterian Church of Yorktown c/o Chip Low

2880 Crompond Road

Yorktown Heights, NY 10598

First Name *

Last Name *

Email Address *

If you are a current member, please complete ONLY the information below that has changed.

Website Address (if applicable)

Preferred Phone Number (xxx-xxx-xxxx)

Would you like the following information listed on our website? (Check all that apply)

Website

Email Address

Phone Number

Address

City

State (2 letters)

Zip/Mailing Code (USA - 5 digits)

Country (if not U.S.)

Coaching Credential

ACC with ICF

PCC with ICF

MCC with ICF

BCC

Other:

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Primary Coach Training Program

Additional Coach Training

I am a:

PCUSA Pastor

PCUSA Ruling Elder

Other:

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Home Presbytery

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