2009 REGISTRATION FORM

This form is for non-secure fax-only or postal mail registration.

Click Here for a SECURE on-line registration form.

Select the type of registration you want
Single Clinic-Individual Single Clinic-Staff Season Pass-Individual Season Pass-Staff

For Season Pass registration, check all clinics you wish to attend.

Pre-Registration Prices
Which Clinic(s) are you registering for?
Check all clinics you plan to attend		 Single Clinic Season Pass
Can attend any or all clinics
Includes Glazier Clinic Online		 Pre-registration Deadline
Individual Staff Individual Staff
Atlanta, GA Extreme...Feb 27-Mar 1 2009   $75.00 $479.00 $200.00 $650.00 10-Feb-2009
Atlanta, GA Galleria...Feb 6-8 2009   $100.00 $495.00 $200.00 $650.00 22-Jan-2009
Baltimore, MD...Feb 6-8 2009   $100.00 $495.00 $200.00 $650.00 23-Jan-2009
Boston, MA...Feb 12-14 2009   $100.00 $295.00 $200.00 $650.00 26-Jan-2009
Charlotte, NC...Feb 19-21 2009   $100.00 $495.00 $200.00 $650.00 2-Feb-2009
Cherry Hill, NJ MEGA...Feb 19-21 2009   $88.00 $345.00 $200.00 $650.00 3-Feb-2009
Chicago, IL Glazier...Mar 6-8 2009   $100.00 $495.00 $200.00 $650.00 18-Feb-2009
Chicago, IL MEGA...Feb 5-7 2009   $88.00 $345.00 $200.00 $650.00 20-Jan-2009
Cincinnati, OH...Feb 19-21 2009   $100.00 $495.00 $200.00 $650.00 4-Feb-2009
Cleveland, OH...Mar 5-7 2009   $100.00 $345.00 $200.00 $650.00 17-Feb-2009
Costa Mesa, CA...Mar 6-8 2009   $100.00 $495.00 $200.00 $650.00 19-Feb-2009
Dallas, TX...Feb 20-22 2009   $100.00 $295.00 $200.00 $650.00 5-Feb-2009
Denver, CO...Feb 13-15 2009   $100.00 $495.00 $200.00 $650.00 29-Jan-2009
Destin, FL...Feb 13-15, 2009   $100.00 $295.00 $200.00 $650.00 29-Jan-2009
Grand Rapids, MI...Feb 19-21 2009   $100.00 $495.00 $200.00 $650.00 4-Feb-2009
Green Bay, WI...Feb 27-Mar 1 2009   $100.00 $295.00 $200.00 $650.00 10-Feb-2009
Harrisburg, PA SVS...Mar 12-14 2009   $70.00 $345.00 $200.00 $650.00 23-Feb-2009
Houston, TX...Feb 26-28 2009   $100.00 $495.00 $200.00 $650.00 9-Feb-2009
Indianapolis, IN...Feb 26-28 2009   $100.00 $495.00 $200.00 $650.00 9-Feb-2009
Kansas City, MO...Feb 12-14 2009   $100.00 $495.00 $200.00 $650.00 27-Jan-2009
Las Vegas, NV...Feb 5-7 2009   $100.00 $295.00 $200.00 $650.00 21-Jan-2009
Minneapolis, MN...Feb 20-22 2009   $100.00 $495.00 $200.00 $650.00 5-Feb-2009
Nashville, TN...Feb 13-15 2009   $100.00 $295.00 $200.00 $650.00 30-Jan-2009
Phoenix, AZ...Apr 3-5 2009   $100.00 $195.00 $200.00 $650.00 18-Mar-2009
Pittsburgh, PA...Feb 20-22 2009   $100.00 $345.00 $200.00 $650.00 6-Feb-2009
Providence, RI...Mar 12-14 2009   $100.00 $295.00 $200.00 $650.00 24-Feb-2009
Santa Clara, CA...Feb 27-Mar 1 2009   $100.00 $195.00 $200.00 $650.00 12-Feb-2009
Seattle, WA...Feb 20-22 2009   $100.00 $495.00 $200.00 $650.00 6-Feb-2009
St. Louis, MO...Feb 27-Mar 1 2009   $100.00 $495.00 $200.00 $650.00 13-Feb-2009
Toledo, OH...Feb 12-14 2009   $100.00 $345.00 $200.00 $650.00 28-Jan-2009
Tulsa, OK...Feb 5-7 2009   $100.00 $295.00 $200.00 $650.00 21-Jan-2009

Must be postmarked or received by the deadline for pre-registration prices. After pre-registration deadline and for onsite registrations, $10 per individual registration or $50 per staff registration has been included in the prices above. Glazier Clinics receives a commission on some hotel rooms purchased by attendees. Glazier Clinics reserves the right to refuse admittance and/or remove any individual from a clinic at its sole discretion. Badges may not be sold or transferred.

NO REFUNDS.

School Name:

 *

Contact Name:

 *

Address:

 *
City, State, Zip: *

Daytime Phone:

 * (999-999-9999)

Evening Phone:

 (999-999-9999)

Fax Number:

 (999-999-9999)

Email Address:

 *

Billing Email Address:

 *

* Entries required

Check here if you need a registration confirmation – you must include your Email Address.

PAYMENT INFORMATION:

Pay by Check. An invoice will be emailed to Billing Address.
Purchase order, PO#:
Pay by Credit Card

Check one: VISA MASTERCARD DISCOVER

Name on card:

Billing address:

Billing city, state, zip:

 , ,

Card Number (16 digits):

Sec. code:

Exp. date:

Signature:

Amount:

 (Numbers only)

PLEASE PHOTOCOPY AND WRITE ON FOR ADDITIONAL COACHES

Name(s) of Coaches you are Purchasing a Registration for (#1 being Primary Contact):
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Athletic Director Name Phone

Courtesy of Riddell, youth coaches attend free. Please enter your local youth league president's name and phone.

President's Name Phone

Comments:
 

SEND OR FAX FORM TO:

Frank Glazier Clinics / MEGA CLINIC
P.O. Box 63673
Colorado Springs, CO 80962-3673
(888) 755-6427 or (719) 536-0069
FAX (719) 536-0073

Copyright ©2009, MEGA Clinics, LLC