Illinois Track and Cross Country Officials Association
Membership Application
January 01, 2006 to December 31, 2007
Name____________________________________________________________________
Mailing Address___________________________________________________________
City______________________________________State__________Zip code__________
Home Phone_____________________Work Cell
IHSA ID ______________E-Mail Address_______________________________________
Check One Official________Coach________Other_____________
Member (Check all that apply) IHSA_______NCAA_______USTAF________
Official's Certification with IHSA
Registered___________Recognized__________Certified____________
How many years as a coach or official___________________
Would you be willing to serve as a committee member_________
Membership dues are $15.00. Date Paid_____________________
Make checks payable to ITCCOA.
Send to:
Mike Powers
205 Aldrin Ave.
Batavia, IL 60510
630-761-8832
Print this page and fill out.
Executive Board
Glenn Cothern - President
Owen Fuller - Vice President
Mike Powers - Secretary/Treasurer
William Bulat - Past President
Membership Application
January 01, 2006 to December 31, 2007
Name____________________________________________________________________
Mailing Address___________________________________________________________
City______________________________________State__________Zip code__________
Home Phone_____________________Work Cell
IHSA ID ______________E-Mail Address_______________________________________
Check One Official________Coach________Other_____________
Member (Check all that apply) IHSA_______NCAA_______USTAF________
Official's Certification with IHSA
Registered___________Recognized__________Certified____________
How many years as a coach or official___________________
Would you be willing to serve as a committee member_________
Membership dues are $15.00. Date Paid_____________________
Make checks payable to ITCCOA.
Send to:
Mike Powers
205 Aldrin Ave.
Batavia, IL 60510
630-761-8832
Print this page and fill out.
Executive Board
Glenn Cothern - President
Owen Fuller - Vice President
Mike Powers - Secretary/Treasurer
William Bulat - Past President
Membership Application
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