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