FISTRAGE Fist Rage “Shoes with Soul” application School Name __________________________________ Address_______________________________________ _______________________________________ Athletic Director/ Administrator __________________ Contact Number ______________________________________ Head Coach __________________________________ Contact Number ______________________________________ Student name _____________________ shoe size ______ color_____ Student name _ ____________________ shoe size ______ color_____ Student name _____________________ shoe size ______ color_____ Student name _____________________ shoe size ______ color_____ Student name _____________________ shoe size ______ color_____ You can su bmit up to 5 students per school. Any additional request please contact program administrator. Athletic Director/ Administrator signature ________________________ Head Wrestling Coach signature ________________________________ F istrage will not disclose any student or athlete name or info on ou r website or any media DIRECTOR OF PROGRAM M A RK MEHLER Mmehler923@gmail.com 336 - 307 - 1532 FISTRAGE 1208 WEST GREEN DRIVE HIGH POINT NORTH CAROLINA 27260