Coach’s Name_____________________________________School________________________

Home Address _________________________________________Home Phone______________

City___________________________________________State__________ Zip_______________

Business Phone_____________________ E-Mail ______________________________________

                                                                             (Please fill in as we are trying to communicate via e-mail)

Circle Correct One:    Boys’ Varsity Coach                       Girls’ Varsity Coach

Boys’ Sub Varsity Coach (JV, jr. high, Frosh)                     Girls’ Sub Varsity Coach

Retired                                                                                Other_______________

Please consider registering your entire staff. Any questions? Call 442-8075

Total Enclosed: ___________ Dues

Please make checks payable to VBCA and mail to:

Dave Fredrickson

317 Silver Street

Bennington, VT 05201