D.M.V Basketball Clinic Registration Form

For D.M.V. Basktball Clinic information, click here.

REGISTRATION FORM

Name:______________________________________________

Program Name:________________________________________

Contact Information
Phone numbers:
Cell: ( ) -
Home/Work: ( ) -

Email Address:_____________________@__________________

Alternate Email:____________________@__________________

Address:_____________________________________________

City:_______________ State:________ Zip Code:_________
Method of Payment:
Certified Check Money Order
Personal Check (only through Sept 13) Online
Costs:
o $75/coach (individual rate)
o $65/coach (Program Rate-3 or more coaches from the same program)
o $65 if registered & paid before September 1st
o $60 (Early Bird Program discount)

Checks will not be accepted after September 13th. Only Certified Checks, Money Orders, or Online Payment.

Please make all payments to: Mike Jones
Send all payments to:
DMV Basketball Clinic
4601 Harvard Rd
College Park, MD 20740
Or
Email to DMVbasketballclinic@gmail.com
with completed registration forms!!!