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IBCA Clinic Registration
April 25 & 26, 2008
Lawrence North
High School
7802 Hague Road, Indianapolis 46256
Use your Browser Icon to Print
School Name
__________________________________________
School Address
________________________________________
City
_________________________ State _____ Zip
__________
Email Address
_________________________________________
Circle One:
Boys Coach
Girls Coach Media Rep
Official Former Coach Other
Registrant's
Coaching
Membership Member Fee Non-Member
Name
Level
Number ($40)
($75)
________________ ________
_____ _____
_____
________________ ________
_____ _____
_____
________________ ________
_____ _____
_____
________________ ________
_____ _____
_____
________________ ________
_____ _____
_____
Total Enclosed $____
$_____
** Add sheet for additional registrations
Mail Registration form and fee(s) to:
Renee Turpa Portage
HS 6450 Rt.6 Portage, IN 46368
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