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2019 Coaching Courses
APPLICATION FORM / FORMULAIRE D'APPLICATION
COST for C Licences:
C1: $175
C2: $175
Evaluation: $100
Full course(C1 & C2) + evaluation: $350
COST for B Licence Part 1:
$500 (Includes: accomodation, meals)
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* Indicates required question
Email
*
Your email
Name/ Nom
*
Your answer
Mailing Address/ Adresse
*
Ie/Ex : 5 Fake Street, Moncton
Your answer
Postal Code/ Code Postale
*
Ie/Ex : E1C X6Y
Your answer
Telephone/ Télephone
*
Ie/Ex : 506-555-5555
Your answer
Club or/ou Association
*
Your answer
Do you have a physical or other disability or a medical condition?/ Souffrez-vous d'un handicap physique ou autres problème médicaux?
*
Yes/ Oui
No/ Non
If yes, please give full details / Si c'est le cas, merci de bien vouloir fournir les détails :
Your answer
My present certification status (Please provide a copy via email to
younes@soccernb.org
)/ Mon niveau de certification à ce jour (Veuillez envoyer une copie via courriel à
younes@soccernb.org
)
Please identify in this order: Licence/ Date/ Location - Veuillez identifier dans l'ordre suivante: License, date, lieu
Your answer
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