________________________________                     ________________________
                                                        CITY                                                           ZIP CODE

PHONE:          (H)______-________-_________                  (W)______-_____-______

                      (C)______-________-_________

E-MAIL ADDRESS:____________________________________________________

E-MAIL ADDRESS #2:                                                                                                         

IHSA SPORT AND REGISTERED LEVEL:

CIRCLE EITHER “X”(REGISTERED), “R”(RECOGNIZED), OR ‘C”(CERTIFIED)

BASEBALL: X   R   C       BASKETBALL:   X   R   C           SOFTBALL:   X   R   C

SOCCER:   X   R   C

Membership fee is $20 for 1 sport and an additional $5 for ALL remaining sports.  Fee will never exceed $25 no matter how many sports you are a member.  Make checks payable to the RVOA

Please mail to: