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Registration Form | 2015 NSCAA Convention
Register Online at NSCAA.com/convention
January 14-18, 2015 • Philadelphia, PA
(To make your registration as error-free as possible, please print or type all information)
First Name _________________________________________________ Middle Initial ______________
Last Name _________________________________
❏ Male ❏ Female
Date of Birth ___________
Home Address ____________________________________________❏ Use this address for mailings
City ______________________________ State ________ ZIP/Postal Code _____________________
School/Organization/Business ________________________ Title ______________________________
Business Address __________________________________________❏ Use this address for mailings
City ______________________________ State ________ ZIP/Postal Code _____________________
Primary Phone __________________________ Other Phone __________________________________
❏ Home ❏ Office ❏ Mobile
❏ Home ❏ Office ❏ Mobile
Email ___________________________________________ Twitter ____________________________
In case of emergency, contact ___________________________________________________________
Relationship________________________________Phone ____________________________________
❏ Check here if you prefer to not receive Convention-related mailings from exhibitors.
CONVENTION NAME BADGE (Please type/print your preference for your badge, maximum 25 characters per line)
Name:
Affiliation:


PRE-REGISTRATION FEES
(Must pre-register by Jan. 13 to register at the rates below.)
Member
$409 = ______ Member No. ________________________________
Student Member
$139 = ______ Member No. ________________________________
Senior Member
$329 = ______ Member No. ________________________________
Non-Member*
$504 = ______
Student Non-Member*
$234 = ______
Must submit a copy of valid Student ID with form.
Must be a current NSCAA member age 62 or older.
Must submit a copy of valid Student ID with form.
Senior Non-Member*
$424 = ______
Upgrade Registration to Sideline Pass
$100 = ______
Guest Registration Fee**
$75 = ______
Guest Name _____________________________________________________________________________
Optional Donation to NSCAA Foundation ____________
*Include one year NSCAA membership
**Guests have access to Exhibit Hall only
Awards Banquet Ticket*
College Awards Reception**
High School/Youth Awards Breakfast**
Women’s Awards Breakfast**
All-America Luncheon*
US Youth Soccer Gala
_____
_____
_____
_____
_____
_____
x $65 = ______
x $30 = ______
x $15 = ______
x $30 = ______
x $65 = ______
x $75 = ______
*On-site tickets will cost an additional $10. **On-site will cost an additional $5.
❏ Female
❏ Both
Role in coaching area:
❏ Head Coach ❏ Assistant Coach
❏ Director of Coaching
❏ Administrator ❏ Retired
❏ Other _________________________
Race/Ethnicity (optional):
❏ Asian/Pacific Islander ❏ Black
❏ Hispanic
❏ Multi-Racial
❏ Native American/Alaska Native
❏ White Non-Hispanic
❏ Portuguese
❏ Other _________________________
POLICIES
• NSCAA Convention registrations are NON-TRANSFERABLE.
• Individuals MUST be 16 years or older to register for the NSCAA Convention.
• Requests for refunds must be submitted in writing. There are no fees
for refunds requested on or before Dec. 16, 2014. A $100 processing fee
will be assessed on all refunds requested after Dec. 16, 2014. No refunds
after Feb. 15, 2015. Refunds will be processed after the event – no refunds
will be made on-site.
• By registering for the NSCAA Convention, I grant the NSCAA permission to
use my likeness in photographs and videos taken during the Convention.
This permission is granted for, but not limited to, all NSCAA promotional
material.
TOTAL $______________
CREDIT CARD PAYMENTS (Fax to 816-474-7408)
❏
I Coach:
❏ Male
• No refunds available for meal ticket purchases.
MEAL TICKETS
❏
Primary coaching area:
❏ Youth
❏ High School
❏ Junior College Div. I ❏ Junior College Div. III
❏ NCAA Div. I
❏ NCAA Div. II
❏ NCAA Div. III
❏ NAIA
❏ NCCAA
❏ Professional
❏ Amateur
❏
❏
Card Number _____________________________ V-Code ______________ Exp. date _____________
Name on card ______________________________ Signature _________________________________
Billing Address _______________________________________________________________________
City ___________________________________ State ___________________ ZIP __________________
• NSCAA strongly recommends advance purchase of tickets to additional
events to ensure availability. A limited number of additional events tickets
will be sold at registration.
MAILING INSTRUCTIONS
(NON-CREDIT CARD PURCHASES)
Attach a check or money order (U.S. funds only) payable to
“NSCAA” and return postmarked no later than Jan. 7, 2015, to:
NSCAA Convention Registration
30 W. Pershing Rd., Suite 350, Kansas City, MO 64108
We cannot accept purchase orders for payment.
Any registration forms received after the deadline will
be returned.