Pennsylvania Volleyball Coaches Association
Registration Form

 Please Print This Form

..... check made payable to PA Volleyball Coaches Assoc
..... mail to Daryl Wessner, 231 South Tulpehocken Street, Pine Grove, PA 17963
570-764-4965      Email .....  dlwessner@comcast.net

Coach _______________________________
Home Address ________________________
_____________________________________
Zip __________________
Home Phone (         )____________________
E-mail________________________________
 

____ Please make only my school number available to members.
 

School  _______________________________

Club  ________________________________

School/Club Phone (     )__________________
 

Please circle all teams you coach

Jr High(F) .....  Jr. High(M)

Jr Varsity(F) .....  Jr Varsity(M)

Varsity(F) ..... Varsity(M)

Collegiate(F) ..... Collegiate(M)

USA/AAU (F) ..... USA/AAU (M)


 High School Coaches

PIAA District #            

Circle all that apply .....
A Girls ..... AA Girls ..... AAA Girls
AA Boys ..... AAA Boys

Other ______________

 

Membership Rates

 Check One .....
_____1 year -- $10      _____3 year -- $25      _____Lifetime -- $200
_____Retired coach - 1 yr $5 (newsletter only)

Check One .....
_____Membership Renewal    ____New Member

Membership valid from July 1 through June 30