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