January 7 – 8, 2005
Louisville, Kentucky
Kentucky International Convention Center
Name __________________________________________________________________
Employer’s name ________________________________________________________
NSCA member # (if applicable) ______________________________
Are you a ? CSCS® or ? NSCA-CPT® ?
Mailing address __________________________________________________________
________________________________________________________________________
City___________________________________ State ________ Zip_________________
Phone_________________________________ Fax _____________________________
Email address ___________________________________________________________
Personal Interest (check all that apply): ? Football ? Baseball ? Other _______________________
What is your primary job responsibility (check only one):
? S&C Coach ? Athletic Trainer ? Phys. Therapist ? Personal Trainer ? Educator ? Student
? Sport Coach—specify sport __________________________ ? Other _______________________
T-shirt size: ? S ? M ? L ? XL ? XXL ? XXXL
Manuals & T-Shirt are not assured for those registering after December 1, 2004.
? Please check here if you require special accommodations. Attach a written \??\[??[?\??YY??[Y\??[??H??X?
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