Longevity Form

MCA Longevity Award Form

MCA Longevity Awards are designed to recognize MCA member athletic coaches, AD's and trainers for years of active service, starting at 15 years.

At 15 years and at 5-year intervals thereafter, MCA purchases your plaque, if you apply.

If you are eligible for a Longevity Award (first awarded at 15 years of service and then in 5-year increments), please submit the following form. Indicate the total number of years (through May 2024) that you have served as coach, AD, trainer or combination thereof, on the line provided.

Awards are not made retroactively. If you have coached 33 years, for example, and have never sent in a longevity form before, you are only eligible for a 30-year award (previous awards are not available).

You must be an active MCA Member, must have coached and/or been an AD or trainer in Montana during this school year, and must have a minimum of 5 years of service in Montana. RETURN BY 6/15/24.

Name*
First Last
Email*

Address*
Mailing address City State ZIP Code

Home Phone*
School*

Longevity Award*
(starting year listed in parenthesis)
1st Year Of Service*
Select school year
Total # of Years*
Please indicate on the line provided, the total number of years, through May 2024, that you have served as an athletic coach, AD, trainer (or combination thereof).

Years Missed
(if any)

Do you plan to attend the Awards Ceremony on Thursday, August 1st, 2024? It will be held at 11:30 AM in the CMR High Auditorium in Great Falls.*

Yes

No
How will you collect your plaque?*
Mailing is expensive and time consuming. Please, if possible, attend the Awards Ceremony to receive your plaque.

I will have a friend pick it up at the awards ceremony (preferred)

Please ship it to me for a $20 shipping and handling fee
Shipping and Handling Fee -
Mailing is expensive and time consuming. Please, if possible, pick up your plaque at the Awards Ceremony or ask someone pick it up for you.
Price:
Total
$0.00
How will you pay for your fees?*

Online

Mail
Payment Method*

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Mailing Address
Payable to:
MCA
375 Ramble Inn Rd.
Fort Shaw, MT 59443
Please mail a check now so you do not forget. Checks will be cashed in June. Plaque will not be mailed without payment.

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