Clinic Registration Form
Please fill in the form below.
Name
First Name
Last Name
Age if minor
Parent/Guardian if minor
Contact Number
*
E-mail
*
Personal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Clinic Goals
Please tell us a little bit about what you would like to accomplish in this clinic
Please check which clinics you would like to register
*
August 16 Obstacle Course Clinic $60
July 22-23 Liberty Clinic with Allison Whisler $300. Lunch and snack provided.
Date
-
Month
-
Day
Year
Date
Type a question
My Products
prev
next
( X )
Obstacle Clinic
$
60.00
Quantity
1
2
3
4
5
6
Liberty Clinic with Allison Whisler
$
300.00
Quantity
1
2
3
4
Stall per night
$
25.00
If attending both clinics; add stall for each. Limited stalls; check availability
Quantity
1
2
3
4
5
6
Turnout
$
20.00
If attending both clinics; add turnout for each
Quantity
1
2
RV Hookup per night
$
10.00
If attending both clinics; add RV hookup for each
Quantity
1
2
3
4
5
6
Auditor with Lunch
$
35.00
Quantity
1
2
3
4
5
6
7
8
9
10
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Submit
Payment Methods
Choose from one of the PayPal options to
make your payment.
Should be Empty: