Soccer New Brunswick Technical Department Soccer New Brunswick 2010 Coaching Courses – Application Form NAME: ADDRESS: POSTCODE:

CITY:

HOME PHONE:

WORK PHONE:

CELLPHONE:

DATE OF BIRTH:

(M)

(D)

(YR)

EMAIL: CLUB REGISTERED WITH:

Present Coaching Certification Level? Please Check

Year and City Obtained

Community Coach – Child Community Coach – Youth Community Coach – Senior NCCP Multi Sport (Part A) NCCP Multi Sport (Part B)

Method of Payment: Please make certified cheques payable to Soccer New Brunswick Total Amount:

$

Note: Application forms received without an accompanying certified cheque will not be considered for enrolment on the course. I agree to abide by the Course regulations, and understand that neither the Soccer New Brunswick nor the Authority which provides the facilities is under any liability in respect of injury which I may sustain.

Signature:

Date:

1

Soccer New Brunswick Technical Department Please enroll in the appropriate Coaching Course – Please check appropriate course(s): 2010 Community Coach - CHILDREN Date

Saturday 8th May

Saturday 29th May

Saturday 5th June

Saturday 12th June

Registration

Region

Fee

Closing Date

South Charlotte County South Arthur Miller Turf Field East Riverview High School South Arthur Miller Turf Field

Friday 23rd April

$30.00 (SNB Members) $115.00 (Non-SNB members) $40.00 (SNB Members)

Friday 14th May

$80.00 (Non-SNB members) $65.00 (SNB Members)

Friday 21st May

$115.00 (Non-SNB members) $40.00 (SNB Members)

Friday 28th May

$80.00 (Non-SNB members)

NOTE: All coaches affiliated to Fundy Soccer Club, please complete the Registration Form and mail it to Soccer New Brunswick WITHOUT Payment.

2010 Community Coach - YOUTH Date

Registration

Region

Closing Date

West Sunday 16th May

$95.00 (SNB Members)

Oromocto Military Base

Friday 30th April $145.00 (Non-SNB members)

Gym Sunday 30th May

Sunday 13th June

Fee

$50.00 (SNB Members)

South Arthur Miller Turf Field South Arthur Miller Turf Field

Friday 14th May $90.00 (Non-SNB members) Friday 28th May

$50.00 (SNB Members) $90.00 (Non-SNB members)

NOTE: All coaches affiliated to Fundy Soccer Club, please complete the Registration Form and mail it to Soccer New Brunswick WITHOUT Payment. 2

Soccer New Brunswick Technical Department 2010 Community Coach - SENIOR Registration

Date

Region

Saturday & Sunday

East

1st & 2nd May

Moncton (TBA)

Saturday & Sunday

South

15th & 16th May

Arthur Miller Turf Field

Closing Date Friday 23rd April

Fee $100.00 (SNB Members) $150.00 (Non-SNB members)

Friday 7th May

$60.00 (SNB Members) $100.00 (Non-SNB members)

NOTE: All coaches affiliated to Fundy Soccer Club, please complete the Registration Form and mail it to Soccer New Brunswick WITHOUT Payment.

Please complete this Application Form along with Payment and Return it to:

Soccer New Brunswick 125 Russ Howard Dr, Unit 2 Moncton New Brunswick E1C 0L7

3

Soccer New Brunswick Technical Department

Technical Department. Soccer New Brunswick. 2010 Coaching Courses – Application Form. NAME: ADDRESS ... Community Coach – Child. Community Coach – Youth. Community Coach – Senior. NCCP Multi Sport (Part A) ... Riverview High School. Friday 21st May. $115.00 (Non-SNB members). $40.00 (SNB Members).

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