MEMBERSHIP FORM
Last Name:__________________________ First_________________________ Middle___________________ |
| Home Address:____________________________________Phone:_______________________________ |
| City:__________________________ State____________________Zip Code_______________________ |
| Name of School:_________________________________________ Class _________________________ |
| Head Coach ___________ Assistant _____________ J.V._____________ Youth______________ |
| Years_____________ Career Record _______________________ |
| Email Address:__________________________________________ |
| Coaching Position________________________________________ |
| School Address:___________________________________ Phone_______________________________ |
| City:__________________________ State____________________Zip Code_______________________ |
| Membership Period January 1 - December 31 |
| Please Check : Renewal____________ New Member_____________ |
| $30.00 Membership |
| Make Checks Payable to: MHSBCA |
| Mail to : Dave Elliot 2157 South Van Buren Reese, MI 48757 |