IHSSCA

AWARD APPLICATION

This application is for those who could not attend the 
IHSSCA Honors Banquet.
To receive this award and a copy of the Honors Banquet Program, please print
the application, complete all the information requested and send both the
application and the award fee to the address listed below.

APPLICATION MUST BE RECEIVED WITHIN 2 MONTHS OF THE BANQUET

1) Award Recipient's Name ________________________________________________________

2) Recipient's Address:

Street: __________________________________________________

Town: __________________________________________-- IL Zip Code ___________________

3) Recipient's Home Phone Number: (____) ________________________________

4) Recipient's High School: _________________________________________________________

5) Coach's Name _____________________

6) Recipient's Award: ___________________________________________________

Be sure to include the $10 Award and Postage fee. Make checks payable to IHSSCA.

The undersigned affirms that the information included in this application is true and accurate.