Iowa High School Swim Coaches Association
Membership Form

Name:
Date:
Date of Birth:
College Attended:
Year of Graduation:
Number of Years in IHSSCA:
Home Address:
City:	State Zip
Email Address:(required)
Home Phone:
School Phone:
School:
School Address:
City:	State Zip
Membership:	Regular Associate Honorary

Coach of Men's: (please circle)	Head Assistant Diving
Coach of Women's: (please circle)	Head Assistant Diving
Coach - Other : (please circle)	U.S.S. Y.M.C.A. College

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Are you currently a member of the National Interscholastic Swimming Coaches Association of American?
Yes
No

If yes, how long?

If you are not a member of NISCA, would you like more information regarding our National Association?
Yes
No

Please print and mail this form and a check made payable to the
Iowa High School Swim Coaches Association in the amount of $20.00 to:

Shawn Thomsen, Secretary Treasurer
Iowa High School Swim Coaches Association
601 36th St. NE.
Cedar Rapids, IA 52402
1-319-365-4594

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