ACSA Team Captain / Coach Membership Form

Adult Competitive Sports Association (ACSA)

Welcome to ACSA.

This form collects the information necessary to activate your ACSA Captain / Coach membership, which is required for individuals serving in a leadership role for teams participating in ACSA-sanctioned leagues or events.

Annual Certification Fees:
• Multi-Sport Certification — $55

ACSA Team Captain / Coach Membership Form

SECTION 1

Personal Information

First Name*

Last Name*

Primary Email*

Date of Birth*

Primary Phone*

SECTION 2

Team Information

Team Name*

League / City*

Example: Montgomery Basketball League

Role

SECTION 3

Sport Participation

Sport*

League Operator Name (if known)

Approximate Number of Players on Team

SECTION 4

Emergency Contact

Emergency Contact Name*

Emergency Contact Phone Number*

SECTION 5

Membership Requirement

Signature Block

Signature

Signature Block

By submitting this application, I certify that the information provided is accurate and complete.