High School, Recreational, Retired, WNFC, WFA, and Flag Football

Terms:

$50 / Year

First Name: First Name Required

Last Name: Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Date of Birth:* Date of Birth is Required

Gender: Gender is not valid

Organization:* Organization is Required

Organization Type:* Organization Type is Required

Please select your primary position. If you have multiple positions please select those that apply, and provide details in the Active Working details box.:* Please select your primary position. If you have multiple positions please select those that apply, and provide details in the Active Working details box. is Required

Career Goals:* Career Goals is Required

Years Active ( Please indicate number of years coaching or managing. Any additional details can be added to the Active Working Details field below. ):* Years Active ( Please indicate number of years coaching or managing. Any additional details can be added to the Active Working Details field below. ) is Required

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Email (Personal):* Email (Personal) is Required

Have you been a Coalition member in the past?:* Have you been a Coalition member in the past? is Required

if yes please provide the email address you used: if yes please provide the email address you used is not valid

Phone Number:* Phone Number is Required

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Description	Amount
High School, Recreational, Retired, WNFC, WFA, and Flag Football – Initial Payment	$50.00
Total	$50.00

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