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BFS Clinic Information Request Form

Please Fill-out the Form Below to Request Information.
Your Contact Information
Fields Marked with * Are Required
Please Select Which Best Describes to you from Drop-Down Menu:    *
First Name: * Last Name: *
Phone Number 1: * Ext.  Phone Number 2:  Ext. 
Email Address: *
Best Contact Phone:  Ext.  Day:   Hour:  
School Information
School Name: *
School Address: *
Additional Address:
School City/State/Zip: * * Zip Code: *
School Phone: * Ext.  School FAX Number:
2nd Contact: 2nd Contact Phone:  Ext. 
Estimated Enrollment: Football Record:
Other Sports Records: Example: Basketball, 12-0 Baseball 15-0, Track, 3 First Place 2 Second Place
Clinic Information
Preferred Clinic Dates
(Make Two Choices) 		First Choice (Date):
 First Choice Day(s) of the Week:
Second Choice (Date):
 Second Choice Day(s) of the Week:
Nearest Airport Airport Name: Miles to Clinic:
Nearest Lodging Hotel Name: Miles to Clinic:
Please Choose the Type of Clinic You Would Like to Host Below *
(You Can Make More Than One Selection)
Yes No
One Day Clinic 		Yes No
Two Day Clinic 		Yes No
Be An 11 Seminar 		Yes No
In-Service Certification 		Yes No
Regional Certification
Please Answer the Following Questions to Better Assist You
Are You BFS Certified? Yes No
Have You Ever Hosted or Attended a BFS Clinic? Yes No
Have You Ever Hosted or Attended a BFS Be An 11 Seminar? Yes No
Please Enter Below Any Comments/Questions You Might Have About BFS Clinics



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