Registration         Back to Main Clinic Page  

Make Checks payable to:                                           Return to:
                     Bureau County Track                    Bureau Valley High School
Clinic Cost:  $75 per coach if  MAILED by Jan.26th     9154 2125 N. Ave.
                    $95 after Jan. 26th or at the Door                Box 329
                                                                                     Attn.: Dale Donner
                                                                                     Manlius IL  61338


School Name____________________                         Coaches:


School Address__________________                         _______________________


_______________________________                     _______________________


City ___________________________                      _______________________

Zip ____________________   

Amount Paid  ___________                                       _______________________


Email address (if any) _____________                       _______________________