Tennessee Coaches Alliance

2013 Membership Form

Please complete and return this form via instructions at the bottom of the page.

Are you a New Member or a Renewing Member

Level of TCA membership applying for: Full Associate Student

Are you currently a member of ICF: Yes No If yes, when does your membership expire? ______

Name: ______Email: ______

Company Name: ______

Address: ______

City: ______State: ______Zip: ______

Work Phone: ______Fax: ______Home Phone: ______

Website URL: ______

Have you completed or are you currently enrolled in a coach training program? Yes No

If yes, which program: ______Is the program is ICF-Accredited? Yes No

Completion date or planned completion date: ______

Please indicate if you hold one of the following ICF credentials: ACC PCC MCC Date: ______

Currently I am coaching: (select one): As a student coach A part-time coach A full time coach

Number of years coaching: 0-2 2-5 5-10 11-20 over 20

My coaching specialty/niche is: ______

Please write your member profile below (75 words or less and in first person) as you would like it to read when posted on the TCA website: ______

To post your photo with your member profile on the TCA website, please email your photo to . Note: Photos must be in .jpg format and will be cropped to fit.

The TCA Membership committee and Board like to acknowledge and appreciate members who invite guests to join the Tennessee Coaches Alliance. Who first invited you to attend a TCA event?______

Please submit your completed form and payment to the TCA Membership Chairperson or Treasurer at monthly meetings or mail your form and payment to Kim Ewell, 1137 Fernbank Dr, Madison, TN 37115. Make checks payable to TN Coaches Alliance for the appropriate amount based on the fee schedule below.

TCA 2013 Membership Dues
Jan. 1 – August 31 = $90; Sept. 1 = $45
Full-time Student = $45 / You will be added to the website and begin receiving notification of meetings within 2-3 weeks.

Ck # ______

Rec’d ______