Coach Registration

Please enter the information requested below

Introduction

The first step in entering the A.H. Nickless Innovation Award competition is to create a Coach Profile.

Before entering any information, please download and read the Official Rules and Regulations of the Award.

NOTE: Bold fields are required.

Personal Information

Please enter the information requested in each space. Privacy: Please read our privacy statement regarding the personal information entered on this form.

First Name:

Last Name:

Home Address:

City: State: MI Zip Code:

Home Phone: Cellphone:

Email Address:

Birthdate (MM/DD/YYYY): Gender: Male Female

Select the High School with which you will be working:

Log In Information

You will be using your email address and password to access your profile infomation area of this website. Please write down the information you enter for future reference.

Password: (A combination of six to 10 letters and/or numbers ONLY. Include at least one uppercase letter and one number. NO special characters. example: !#$%*@, etc.)

Agreement I have read and agree to follow the Official Rules and Regulations of the Award.

Verification

Verification Information

Type the characters you see in the picture. This ensures that a person, not an automated program, created this profile.

Picture:

Characters:

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