Wufoo

LICCA Competition Registration Form

Long Island Cheerleading Coaches Association
*You must be a LICCA member in good standing to register*
*Your registration will NOT be accepted if you are not a member*
*Once you submit this form you may not cancel*

Competition Location and Date
School Name *
School Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
School Phone Number * - (###) - ### ####
School Colors & Mascot
Coach's Name * Title First Last Suffix
Coach's Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Coach's Phone Number * - (###) - ### ####
Coach's Email Address *

Carefully type in your email address. If your email address is not correct, you will not receive your confirmation.
Division * Middle School Freshmen Junior Varstiy Small Varsity Large Varsity
Please select the division that you will be competing in
Do Not Fill This Out