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MHSSCA Membership & Clinic Form 2023-2024
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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* Indicates required question
Email
*
Your email
High School
*
Your answer
Division
*
1
2
3
4
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
*
Your answer
Last name
*
Your answer
Email Address
*
Your answer
Complete Mailing Address (house number street name, city, zip code)
*
Your answer
Phone number
*
Your answer
Were you a MHSSCA member in 2023?
*
Yes
No
First & last name of coaches attending clinic with you if they are
NOT
filling out their own form.
Your answer
Varsity Level Head Coach ONLY
(no assistants, JV, JV b, or freshmen records)
Varsity Coaching Record (wins-losses)
Your answer
Years of being a MHSSCA member. Reply with a number only, anyone new will enter 0.
*
Your answer
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)
*
0
1
2
3
4
5
6
7
8
9
10
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
Clear selection
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
Required
A copy of your responses will be emailed to the address you provided.
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