NHSSCA Pre-Order Request Form
Please complete this form to submit a pre-order to the NHSSCA. If you have any questions about completing this form, please contact tom.matthews@nhssca.us
Name of your Organization/School
*
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Contact Name
*
First Name
Last Name
Your Contact Phone Number
*
Please enter a valid phone number.
Your Contact Email
*
example@example.com
CLICK HERE
to receive the NHSSCA W9 tax form.
Account Payable Contact Name
First Name
Last Name
Accounts Payable Phone Number
*
Please enter a valid phone number.
Accounts Payable Email
*
example@example.com
Preferred method of payment
*
Please Select
Purchase Order
Bank Transfer (ACH)
Credit card
Check
Wire Transfer
Goods Requested (select all that apply)
*
NHSSCA Professional Membership – $100 per person
NHSSCA High School Strength Coach Certification (HSSCC) ONLY - $199 per person
NHSSCA-HSSCC Group Rate (5+ coaches enrollment) - $150 per person
NHSSCA Standard Membership – $50 per person (NOT HSSCC ELIGIBLE)
NHSSCA Student Membership – $25 per person
NHSSCA Standard Membership, Staff Package – $250 (NOT HSSCC ELIGIBLE)
NHSSCA Groups Admin: $99 annually. Allows coach(es) and admin(s) to view learner progress and communicate via a private group forum.
State Clinic Registration, Non-Member – $100 per person
State Clinic Registration, Standard Member – $75 per person
State Clinic Registration, Professional Member – $50 per person
State Clinic Registration, Student Member – $25 per person
List the first and last name(s) and email(s) of the individual(s) for whom the purchase(s) is intended. Upon successful submission and purchase by your school, we will ensure the name(s) below receive a unique coupon code to apply for a zero balance at checkout.
Submit
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