Pittsburg State University
55th Annual Coaches Clinic


June 20-21 * Lamplighter Inn (formerly Parkview Inn) * Pittsburg

REGISTRATION FORM

This form is for clinic registration only.

All hotel room reservations are handled through the
Pittsburg Holiday Inn Express (Reservation Request).

Make checks payable to Pitt State Football Clinic.

Send this form and check to:

David Wiemers, Football Office
Pittsburg State University
Pittsburg, KS 66762-7504
Attn: Coaching Clinic

Coaches Attending:________________________________________________

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School(s):________________________________________________________

Signature of Coach
Making Reservation:_______________________________________________