One-On-One Goalie Camps

ONCE YOU HAVE SENT IN YOUR APPLICATION and DEPOSIT YOU WILL RECEIVE CONFIRMATION INCLUDING DIRECTIONS, WHAT TO BRING, MEDICAL FORM AND DETAILED CAMP DAY SIGN-IN INFORMATION ENROLLMENT IS LIMITED! FIRST COME — FIRST ENROLLED! We are now offering ONLINE REGISTRATION! Just click the link below and follow the directions. ONE ON ONE ONLINE REGISTRATION LINK ---------OR-------- PLEASE PRINT OUT THIS APPLICATION, FILL IT OUT, AND MAIL THE APPLICATION, ALONG WITH YOUR DEPOSIT TO: Dynamic Lacrosse Training P.O. Box 863 Melville, NY 11747
ONE-ON-ONE ACADEMY OF GOALTENDING APPLICATION 2012
NAME (please print):__________________________________________________ GRADE (as of March 2012): ____________ # of Years Experience _________________ ADDRESS: _________________________________________________________ CITY:_____________________________________ ST:_______ ZIP:___________ PHONE: (_____) _________________E-MAIL:_____________________________ PARENTS OR GUARDIAN’S SIGNATURE / DATE: _________________________________________________

PAYMENT

CLINIC LONG ISLAND SPRING (4 SUNDAYS)	$ 375
CAMP LONG ISLAND SUMMER - FEATURED CAMP	$ 375

DISCOUNT - subtract $25 if you sign up for multiple sessions	$
ENCLOSED IS MY NON-REFUNDABLE DEPOSIT ($150 per session)	$_ 150_______
BALANCE DUE	$