Are You an OYSAN Member? 
YES  NO, I am not a Member

What league do you coach in?
Select Leaguen/a Rocky River Soccer Organization1 OYSAN RefereeAkron Metro Futbol ClubAlliance Futbol LeagueAmerican Amateur Soccer LeagueAmherst Youth Soccer AssociationAnthony Wayne United Soccer ClubAppleseed Youth Soccer AssociationAustintown Junior Soccer LeagueAvon Lake Soccer OrganizationAvon Soccer League AssociationBay Area Soccer LeagueBay Soccer ClubBeaver Youth Soccer AssociationBlack Swamp Soccer LeagueBoardman Soccer AssociationBrecksville Soccer OrganizationBrecksville Travel Soccer AssociationBrunswick Soccer AssociationBuckeye Soccer Association Inc.Canfield Soccer ClubCloverleaf Soccer AssociationColumbia Soccer AssociationEast Liverpool Youth Soccer LeagueEastlake Soccer AssociationEastside Kickers/Heights United Soccer ClubEuclid Youth Soccer OrganizationEuros Juniors Soccer LeagueField Youth SoccerGeneva Recreational Soccer LeagueGreater Akron Amateur Soccer AssociationGreen Soccer AssociationHammer Soccer LeagueHancock Soccer AssociationHarrison Youth Soccer LeagueHighland Youth Soccer Inc.Hogg Creek Soccer LeagueHuron County Youth Soccer ClubJefferson Kiwanis Youth Soccer ClubKenston Futbol ClubKirtland Soccer LeagueLaGrange Youth Soccer AssociationLake County Scheduling LeagueLorain County Soccer LeagueLoudonville Youth Soccer AssociationMadison Soccer LeagueMantua Soccer AssociationMaumee Youth Soccer AssociationMcComb Soccer ClubMedina Soccer Association Inc.Mentor Soccer ClubMidview Soccer LeagueNordonia Hills Soccer AssociationNorth Olmsted Soccer OrganizationNorth Ridgeville Amateur Soccer LeagueNorth Royalton Soccer ClubNortheast Ohio Soccer LeagueNorthern Ohio Elite Soccer Academy Northern Ohio Girls Soccer LeagueNorthwest Ohio Youth Soccer LeagueNorton Amateur Soccer ClubODP Region II RefereesODP Region II VolunteersOhio Amateur Soccer LeagueOlympia Youth Soccer LeagueOYSANOYSAN (Jefferson United)OYSAN BODOYSAN ContactsOYSAN League PresidentsOYSAN MiOYSAN MRLOYSAN ODPOYSAN RegistrarsOYSAN State LeagueOYSAN State League Div IIIOYSAN Test League for WorkshopOYSAN TTPacesetter Soccer ClubParma Soccer AssociationPerry Township SoccerPerrysburg Soccer ClubPerrysburg United Soccer AcademyPoland Youth Soccer AssociationPutnam County Youth Soccer League EastRegion II Boys ODPRegion II Girls ODPRegion II RefereesRevere Soccer ClubRootstown Soccer ClubSebring-West Branch Soccer LeagueShaker Youth Soccer AssociationSheffield-Sheffield Lake Youth Soccer AssociationSolon Lightning Soccer ClubSouth Amherst Firelands UnitedSouth Range Soccer ClubSoutheast Soccer Association Inc.Springfield Soccer AssociationSt. Clairsville Area Soccer AssociationStrikers Soccer Club, Inc.Tallmadge United Soccer ClubTOPS NOSOTOPS YAYSLTT SpecialTuscarawas County United Soccer AssociationTwinsburg A.C. Soccer ClubValentis Athletica Soccer ClubVermilion Soccer ClubWadsworth Amateur Soccer AssociationWashington Local Soccer ClubWaterloo Soccer League, Inc.Wellington Soccer AssociationWestlake Soccer AssociationWickliffe Soccer ClubWilloughby Soccer LeagueYoungstown Area Youth Soccer League

Select the Coaching Course You Would Like To Attend:
Select a CourseYouth Module U10-U12-Mansfield-TBA 3/20/2010 Fee: $110.00Youth Module U10-U12-North Olmsted 3/20/2010 Fee: $110.00D Coaching Course-Mansfield-TBA 3/21/2010 Fee: $220.00Youth Module U10-U12-Copley Rd. 3/27/2010 Fee: $110.00Youth Module U10-U12-Toledo-Area 3/27/2010 Fee: $110.00Youth Module U10-U12-Youngstown Area 3/27/2010 Fee: $110.00D Coaching Course-Copley Rd. 3/28/2010 Fee: $220.00Youth Module U10-U12-Cleveland East-TBA 4/9/2010 Fee: $110.00Youth Module U10-U12-Copley Rd. 7/24/2010 Fee: $110.00D Coaching Course-Copley Rd. 8/6/2010 Fee: $220.00Youth Module U10-U12-Cleveland West 8/7/2010 Fee: $110.00
*Additional facility fees may be required by each hosting organization. You can find out the actual fee by contacting the individual Coaching Course Coordinator. This fee will be due at, or prior to, the first class.

PERSONAL INFORMATION:
Name of Person Attending Course:

First Name:	Last Name:

Last Four Digits of Social Security Number:

Gender: 
Male  Female 
Date of Birth (mm/dd/yyyy) :

Contact Email Address:

Street Address:

City:

State:
OhioMichiganIndianaPennsylvania
Zip:

Home Phone:
- -
Work Phone:
- -

Name of Club/Organization with Whom You Are Coaching
(abbreviate if needed, list only one club or organization): 

Level of Team(s) You Coach: 
Recreational  Travel Premier
Age Group(s) You Coach (i.e. U6-8, U9-12, etc.):

Is the Team Affiliated with Ohio Youth Soccer Association North?
YES  NO  Don't Know

Highest Level of Coaching License You Hold:
None  Youth  E  D  C  B  A
What Organization Issued Your Current License?
US Soccer (USSF)  OYSAN  NSCAA  Other
License Number:

Date Above License Was Received (format 2/23/01):

Type of Payment: Check Credit Card 

CREDIT CARD PAYMENT INFORMATION:

Name on Credit Card:

Credit Card Type:
Visa  Mastercard
Credit Card Number (ie 4044044440444044 - no hypens or dashes or slashes):

Expiration Date:
Month 01 02 03 04 05 06 07 08 09 10 11 12 / Year 06 07 08 09 10 11 12 13 14 15 16 17 18
Cardholder's Street Address: (not City and State)

Cardholder's Zip:


AGREEMENT TO PARTICIPATE:
OYSAN Coaching Schools are open only to members of OYSAN.  If your organization is not affiliated, you must join OYSAN as an Associate Coach by submitting a $30.00 registration fee and a Risk Management form.   Membership benefits such as insurance for an Associate Coach are in effect only when coaching in activities with an affiliated organization.   I understand that OYSAN coaching schools are for member coaches of OYSAN, and that I must join in order to participate.  I also understand that my participation in the course is voluntary and that I must be willing and able to demonstrate and physically participate in many of the course activities.  To the best of my knowledge I am physically capable of participating in the sport of soccer.  I hereby release and indemnify any member of the OYSAN Coaching School staff, the owner and/or operator of the facility or facilities, the Board of Directors of the OYSAN, employees, volunteers or agents of OYSAN or from any organization assisting in this course from any liability due to my participation in this coaching course. 

I Agree to Above. AGREEMENT FOR ELECTRONIC SUBMISSION:
I/we (above indicated) hereby acknowledge that I/we have reviewed this form and caused it to be electronically executed with the intent to be bound to the terms contained herein.

If desired, make sure to print a copy of this submission form for your records BEFORE pressing the "Submit Registration" button below.



Note: Do not press the "Submit" button more than once. Doing so may result in your credit card being charged twice. Your statement will show a charge from "Ohio Youth Soccer Association North". For help email bernie@oysan.org