LSCA PRESIDENT
Dorinda Beaumont
3015 Broussard St.
Baton Rouge, LA 70809

Please Print
Name_________________________________________________________________

            Last              First             Middle Initial

Title: Head Coach______ Assistant Coach______ Volunteer_______

School/Organization__________________________ Class ____________

School Address___________________________________________________

_________________________________________________________

City                                         Zip Code

School Phone #_______________________Fax # ___________________

Home Address___________________________________________________

_________________________________________________________

City                                          Zip Code

Home Phone # _____________________ E-mail ________________________

Cell Phone # _______________________

Please send my LSCA Correspondence to my Home_____ School_____ E-mail _____
Note: **Any summer correspondence is sent to your e-mail address or home address! **

Type of Membership:

_____Regular (High School coaches): $40.00
_____Additional Coach at same school: $30.00
_____Associate (ASA, Youth Organization, etc.): $20.00
_____Hall of Fame & Past Presidents: Free

Make Checks payable to: Louisiana Softball Coaches Association

Mail form and dues to:

Helen Funk
356 Lovers Lane
Baton Rouge, LA 70806

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