MEMBERSHIP APPLICATION 

Simply print the application below and send in with your check or credit card #.   We now have online registration for coaches who want to pay by credit card. PLEASE FILL OUT COMPLETELY!

Oregon Athletic Coaches Association 2012-2013 Dues

Membership Type ( select one )

Regular ( $45)    Gold ($60) ( must be ASEP/NFICEP certified)   

Retired ($35)    Retired Gold ($50)   (must be retired from coaching & teaching) 

Membership Renewal _____ or New_____ (select one)      

Name: ________________________________________

School: _______________________________________

Home Address: ________________________________

City: _____________________ Zip: _____________

Home Phone: ________________________ 

**Email: _________________________________THIS IS VITAL FOR EFFECTIVE COMMUNICATION.  ALL NEWSLETTERS ARE SENT VIA EMAIL.  PLEASE WRITE CLEARLY.

ASEP certified?  _____ Yes _____ No

Primary Coaching Duties - Sport:_______________________________

Head Coach ____    Asst. Coach ____    Boys ____   Girls ____

Additional Coaching Responsibilities:____________________________

Years in Coaching (including current year): ____________(we use the information provided here in awarding plaques each year for 25, 30, 35, 40, 45 & 50 years, please fill out accurately)

Make checks payable to Oregon Athletic Coaches Association or write your credit card info below

Credit Card type & # _____________________________ Exp. date _________

Return to your Athletic Director or Mail directly to:  

OACA / 3295 Triangle Drive, Suite 100  Salem, OR 97302