WFCA APPLICATION FOR LIFETIME MEMBERSHIP

NAME: ______________________________________ AGE: _______

STREET ADDRESS: _________________________________________

CITY: _________________________ STATE: _______ ZIP: _____

PHONE: ________________________

COACHING EXPERIENCE: (please list school and years):

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Mail this form along with a $100.00 check made out to WFCA to:

                        Dick Rundle, Executive Director
                        Wisconsin Football Coaches Association
                        5111 Arrowhead Drive
                        Monona, WI 53716