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RENEWAL FORM FOR INDIVIDUALS
This is out of state coaches, college coaches, media, officials, retired coaches, fans, and friends of Indiana Basketball. Head High School or College Coaches registering themselves and staff click here.

Indiana Basketball Coaches Association
Membership Application

MEMBERSHIP INFORMATION:

* School:

* Type:

* I am a:

Annual Fees:

$20.00

$15.00

Active Coaches - includes a one million dollar liability policy

Former Coaches, College Coaches, Officials & News Media. Does NOT include Million Dollar policy.

* District:

District?
(1, 2 or 3)

* Name:

Address:

City:

State:

Zip:

Phone:

Fax:

* Email:

Please print this form and mail FORM and a CHECK to: Marty Johnson, Whiteland High School 300 Main Street, Whiteland IN 46184.

To PRINT: 1) Use the Print Icon at the top of page (Browser Icon) OR 2) Right Click your Mouse-Right Button-Choose Print.

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