USA Volleyball: USA CAP Course Registration Form

USA CAP COURSE REGISTRATION FORM


Boldfaced item are required.
Name:
Title:
SS#:
Birthdate:
Gender:	Female Male
Volleyball Club:
Send Mail To:
School/Employer:
School Address:
School City:
School State:
School Zip Code:
School Phone:
School Fax:
School Email:
Home Address:
Home City:
Home State:
Home Zip Code:
Home Phone:
Home Fax:
Home Email:

REGISTRATION TYPE: Full Accreditation Level I - CHRVA Member: $150 - Early Registration $200 - Less than 2 weeks before course Level I Renewal - Please Call (888) 786-5539 For Prices
Full Accreditation Level II - CHRVA Member: $175 - Early Registration $225 - Less than two weeks before course Level II Renewal - Please Call (888) 786-5539 For Prices
To receive the early registration discount, your registration form and course fee must be received no later than July 19, 2002, unless otherwise specified.
Course Site: University of Maryland, Reckord Armory (College Park, MD)
Course Date: August 2-4, 2002

Previous USA CAP Courses Attended:
Level:
Year:

Years of Volleyball Experience:
Head Coach: Assistant: Volunteer:
Primary Coaching Level:
Are you a member of AVCA?	Yes No
Are you a certified teacher?

If you require special accommodations because of a disability, please detail your requirements:

Ethnicity (Optional):
How did you hear about USA CAP?: