Mike Puhallo Memorial Scholarships
Entry Form

Supported by the BC Cowboy Heritage Society

Name:__________________________________________________________________
Address:___________________________________________
City: _____________________________________
Province/State: _____________ Zip/Postal code:__________
Phone:(____)____________________ Email:___________________________

Will you be attending a post secondary institution in the next 12 months? _____
What are your courses of study going to be? _________________________
What is the name of your present school or college? ________________________
Please list the name or names of a teacher or counsellor as a referral.
_____________________________________________________________________

What was the date of completion of your poem? ______________________

I wish to enter the Mike Puhallo Memorial Scholarship contest. I have read, understand, and accept the rules and conditions.   Signature:___________________________

Print this form, SIGN it, scan it, and email it with your poem as per the rules, to: cowboys@bcchs.com   Entry deadline December 31st Annually.

Good luck. We look forward to getting your entry.

Supported by the BC Cowboy Heritage Society

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