I.H.S.W.C.A.

INDIANA HIGH SCHOOL WRESTLING COACHES ASSOCIATION

MEMBERSHIP (ONLY) FORM

NAME ____________________________________ SCHOOL NAME ________________________

E-MAIL ADDRESS ________________________________________________________________



HOME ADDRESS _________________________________________________________________


CITY ______________________________________ STATE ______ ZIP _____________________


CELL PHONE (___)__________________              

Coaching Level

Head Coach ___ Assist ___ Jr. High ___ Official ___ Other ___

CHECK THE MEMBERSHIPS THAT YOU WISH TO PURCHASE          

IHSWCA - $30.00   ________ Associate/Retired/Officials - $20.00 _______  

NWCA - $40.00       ________  

TOTAL AMOUNT ENCLOSED FOR THIS COACH $_____________

Make all checks payable to I.H.S.W.C.A. and send to:

J.D. Minch - IHSWCA Executive Director

202 S. Vine St.

Crawfordsville, IN.   47933

Phone:765-376-5638

jsaminch123@sbcglobal.net

DO NOT USE THIS FORM FOR CLINIC REGISTRATION