WISCONSIN FOOTBALL COACHES ASSOCIATION MEMBERSHIP FORM


I.  CHECK AS APPROPRIATE

[ ] NEW MEMBERSHIP
[ ] RENEWING MEMBERSHIP FOR CURRENT YEAR
[ ] CHANGE SCHOOL
[ ] CHANGE HOME ADDRESS
                        ___________________________
                        (OFFICE USE ONLY) [        ]

II.	MEMBERSHIP CATEGORY/FEE (CHECK ONLY ONE):

[ ] $45.00/$35.00  	COLLEGE COACH		[ ]HEAD     [ ]ASSISTANT/YOUTH
[ ] $45.00/$35.00 	SENIOR HIGH COACH		[ ]HEAD     [ ]ASSISTANT/YOUTH


Ill.  INFORMATION (PLEASE TYPE OR PRINT CLEARLY)

SCHOOL: _______________________________________________________

SCHOOL ADDRESS: _____________________________________________

CITY/STATE/ZIP: ________________________________________________

CONFERENCE: __________________________________________________

MEMEBER NAME: _______________________________________________

HOME ADDRESS: ________________________________________________

CITY/STATE/ZIP: _________________________________________________

PHONE: __________________________________________________________

E-Mail: __________________________________________________________

COMPLETE SECTIONS I, II AND III OF THIS FORM 
AND MAIL WITH PAYMENT TO:

SEND TO:  WFCA Office, P.O. Box 8, Poynette, WI  53955

QUESTIONS:  Call Charna at 608-635-7375.

	MAKE CHECKS PAYABLE TO WFCA

    WFCA MEMBERSHIP EXPIRATION DAY BEFORE SPRING.
    TO QUALIFY FOR WFCA AWARDS MEMBERSHIP MUST BE
    RECEIVED NO LATER THAN SEPTEMBER 1.