ANDREW S. & MARGARET LOECHNER JR. SCHOLARSHIP 

Complete this application, print it and send to Mr. Dean Amick, 3544 S. Atherton St., State College, Pa. 16801.

NAME:             DATE:

ADDRESS:

CITY:         

STATE:          ZIPCODE:  

PHONE:           EMAIL:

How I am or my family involved in ASA:       Player  Umpire   Commissioner Other