2017-2018 NCA MEMBERSHIP REGISTRATION
- To pay via CREDIT CARD: Complete this form and click "Continue to Credit Card Payment Screen" to enter your credit card information. Once you have completed credit card payment, your registration is complete. You will NOT need to mail in a copy of this form.
- To pay via CHECK: Complete this form and click "Print Registration Form & Mail with Check" to print your registration form and mail to the NCA office with your check. When you click this button, you will be shown a printer-friendly version of your form as well as the address to mail it with your check.
- If you wish to print this form and fill it out by hand, you can Click Here.
|Gender:|| Male Female|
|Date of Birth:||//|
|Nebraska High School:|
|Out of State High School:|
(Please do not enter school address)
|City, State Zip:||, |
|Phone:||() - |
| First time coach (Check here if you are coaching for the first time ever, not if you are coaching for the first time at a specific school.)|
|Number of years in coaching/administration through 2016-2017: |
Coaching Assignments 2017-2018:
For each sport you are coaching in 2017-2018, indicate if you are the Head Coach or Assistant Coach as well as which level you are coaching.
Administrative Assignments 2017-2018:
Please indicate any administrative positions you hold for 2017-2018 for the high school you selected above.
Assistant Athletic Director
Registrant is a College Student or Coaching Out-of-State for 2017-2018 (membership fee waived).
Registrant is a Past President of the NCA Board (membership fee waived).
|Clinic:|| (The clinic registration fee is $50 until 05/31/2017, after which it increases to $60.) |
|Cheer/Dance 1-Day Clinic ONLY:|| (The Cheer & Dance clinic registration fee is $25 until 05/31/2017, after which it increases to $30.) |
|Additional Options:|| NCA Gold Card ($20.00)|
|Total Amount Due:||$ |
| OR |