Coaching Course Online Registration Form
Fill out the form below completely and press "Submit Registration".
Please type in information carefully and check over your form before submitting.

COURSE INFORMATION:

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

What league do you coach in?

Select the Coaching Course You Would Like To Attend:

*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:

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  A
What Organization Issued Your Current License?
US Soccer (USSF)  OYSAN  NSCAA  Other
License Number:

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


e-Register with Confidence

Secure transactions for the OYSAN.org website are performed via ssl.Hammerhead.net,
which uses a Thawte certificate to ensure secure transmission of your information.

Ohio North Accepts
these Credit Cards:

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:
/
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