Clinic Registration

NAVIGATION CLINIC REGISTRATION

Please read first!

Clinic registration may be paid the day of the event or you may reserve your spot by mailing us a check. Class size is limited to 40 participants.

Items with an * are required fields.

Clinic Location

First Name: *

Middle Name:

Last Name: *

Gender: *

Male

Female

Birthdate:

Email: *

Enter Email Again: *

Day Phone: *

ext.

Evening Phone:

ext.

Address Line 1: *

Address Line 2:

City: *

State: *

Country:

Zip: *

Race Information

Confirm Race Location*

How did you hear about us?

Special Notes or Instructions

Payment Info

Method of Payment

Check Number

You will be directed to a payment page to complete your registration.

Remember that you must complete the payment process to be registered.

**Please print a copy of the final invoice for your records.