2016-2017 District 7 Basketball Coaches Association Membership Application
Make checks payable to: NOD7BCA

Send checks to:
Brian Leppelmeier, NOD7BCA, Treasurer
Pettisville High School
P.O. Box 53001
Pettisville, OH 43553

Membership Dues $35 per Boys Staff and $35 per Girls Staff if registered and paid before October 31, 2016.

Membership dues are $40 per staff if paid after October 31, 2016.

Application and Membership Dues Deadline: November 30, 2016

Membership Questions: Email Brian Leppelmeier at bleppelmeier@pettisvilleschools.org

Please indicate which staff is being paid for on the check.

School Name *
Your answer
School Phone Number *
Your answer
School Mailing Address *
Your answer
Your Team's Division *
Your Team/Staff *
Head Coach *
Your answer
Head Coach's Shirts Size *
In case you are chosen to coach in the district all-star game
Coach's Home Phone Number *
Please mark N/A if you do not have a home phone
Your answer
Coach's Cell Phone Number *
Please mark N/A if you do not have a cell phone
Your answer
Coach's Email *
Your answer
How many years as head coach at current school *
Include the 2016-17 season
Your answer
Your Record at Current School *
Your answer
Overall Years as Head Coach *
Remember that Arzen awards are reported to the OHSBCA through their website, not the local district association
Your answer
Career Record *
Remember that it is your responsibility to report plateu wins to the OHSBCA through their website
Your answer
Athletic Director's Name *
Your answer
Athletic Director's Email *
Your answer
Nominations for Retired Coach of the Year/Hall of Fame/Special Honoree (Non-Coach)
You may be contacted for follow up information
Your answer
So that we can improve our release of important district information, please list your local media outlets
This could include, television, newspaper, radio, internet
Your answer
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