The Coaches Site Registration Form
SAMHA 2022/2023
Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Contact Email:
*
example@example.com
Team Number:
*
Position:
ie. Coach
Billing Address:
*
Street Address
Street Address Line 2
City
Province
Postal Code
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The Coaches Site - Individual Membership
(12-month)
$
30.00
CAD
Quantity
1
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First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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