All State Patch Order Form |
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Name ___________________________________________________ |
School ______________________________________________________ |
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Address _________________________________________________ |
City_______________________ |
State_____ |
Zip______________ |
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Class (circle one) 5A 4A Private Schools |
Number of patches ordered @ $8.00 each |
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Event Qualified (circle event(s)) |
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200 Yard Medley Relay |
100 Yard Freestyle |
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200 Yard Freestyle |
500 Yard Freestyle |
Total amount enclosed |
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200 Yard Individual Medley |
200 Yard Freestyle Relay |
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50 Yard Freestyle |
100 Yard Backstroke |
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One Meter Diving |
100 Yard Breaststroke |
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100 Yard Butterfly |
400 Yard Freestyle Relay |
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Water Polo |
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Terri Morse
1504 Park Street
Pecos, TX 79772Make Checks payable to: TISCA
Class 4A, 5A and Private School TISCA All State Patches
