NHSSCA Pre-Order Request Form

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

CityState / Province

Postal / Zip Code
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Contact Name*

First NameLast 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 NameLast Name
Accounts Payable Phone Number*
Please enter a valid phone number.
Accounts Payable Email*
example@example.com
Preferred method of payment*
Goods Requested (select all that apply)*

NHSSCA Professional Membership – $100 per personNHSSCA Standard Membership – $50 per personNHSSCA Student Membership – $25 per personNHSSCA Standard Membership, Staff Package – $250 (NOT HSSCC ELIGIBLE)State Clinic Registration, Non-Member – $100 per personState Clinic Registration, Standard Member – $75 per personState Clinic Registration, Professional Member – $50 per personState Clinic Registration, Student Member – $25 per person2024 NHSSCA NatCon + PreCon // EARLY BIRD SPECIAL - SALE ENDS APRIL 30, 2024 [Includes Professional Membership] - Non-Member - $3252024 NHSSCA NatCon // EARLY BIRD SPECIAL - SALE ENDS APRIL 30, 2024 // Non-Member - $3002024 NHSSCA NatCon + PreCon [May 1 thru June 22nd] - Non-Member - $4502024 NHSSCA NatCon [May 1 thru June 22nd] - Non-Member - $3502024 NHSSCA NatCon + Pre-Con - Standard Membership - $3122024 NHSSCA NatCon - Standard Membership - $2622024 NHSSCA NatCon + PreCon - Professional Membership - $2252024 NHSSCA NatCon - Professional Member - $1752024 NHSSCA NatCon + PreCon - Student Membership - $1572024 NHSSCA NatCon - Student Membership - $107NHSSCA-HSSCC (High School Strength Coach Certification) Beta Version Rate (available until early 2025) - $150 per personNHSSCA Professional Membership ($100) + HSSCC Beta ($150) Bundle - $250 per personNHSSCA Groups Admin: $99 annually. Allows coach(es) and admin(s) to view learner progress and communicate via a private group forum.
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.
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