Agreement to Publish Club & Club Point Of Contact Information on the Washington State Wrestling Association Web Site:

http://www.WashingtonStateWrestling.com

By filling out specific information below, I agree to authorize WSWA to publish only the information I have filled out on the State Wrestling Web Site.

Printed Name:

Club Affiliation:

Signature:

Club Name:

Club Point Of Contact Name:

Phone Number: ( )

Fax Number: ( )

Address:

E-Mail Address:

Club Web Site:

Surrounding Counties (close to area of practices):

Surrounding Cities (close to area of practices):