OKLAHOMA KIDS WRESTLING ASSOCIATION, INC.

MEMBER CLUB DATA

CLUB FORM 1A

REGION:____________ DATE: _________

CLUB NAME:
CLUB MAILING ADDRESS: Please give complete address
		Address:
		City, State, Zip & Email:
MEMBER TO CONTACT:
PHONE NUMBER: (HOME): ( ) - (BUSINESS): ( ) -
HEADCOACH: PHONE #: ( ) -
COACH’S ADDRESS:	Address:
	City, State, Zip:
NAME AND ADDRESS OF PRACTICE SITE:			Name:
			Address:
			City, State, Zip:

COMMENTS TO STATE PRESIDENT FOR REVISIONS TO BYLAW, ETC:

REGIONAL DIRECTOR NOMINATION: ____________________________

CLUB FORM 1A

Please give complete information. Please print in black ink.