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Application for "D" License Wavier P.O. Box 667 Millersville, Md 21108 410-987-7898
Application for “D” License Wavier
Club Affiliation: __________________________________________________________ Name: ____________________________ Email: _____________________________ Address: __________________________ City, State, Zip: ______________________ Home phone: ______________________ Work or cell phone: ___________________
Playing Experience
Professional team: ________________________________________________________ College: ________________________________________________________________ High School _____________________________________________________________ Other: __________________________________________________________________
Coaching Experience
Professional team: ________________________________________________________ Club: ___________________________________________________________________ College: ________________________________________________________________ High School _____________________________________________________________ Other: __________________________________________________________________
Coaching License / Certificate Held (Attach copy)
Level: _______________________________________ Date: _________________ Licensing Organization: _________________________ License #: _____________
Please mail this completed application with all appropriate documentation two weeks before the course you wish to attend.
A wavier does not give you a license. A granted wavier gives permission to enter a higher level course.
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