Clinic Request Form

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	Use this form to Request a TYSL Clinic with a professional trainer.

Your Team Name

Your Name

Your E-mail

How many clinics would you like me to schedule from these choices?

Team Age Group

Team Gender

Your Cell Phone #


	FIRST Choice for clinic:

List First Choice of Date in d/m/y format


	SECOND Choice for clinic:

First Choice Day of the Week

First Choice of Time


	6:00 or 7:00 Monday thru Thursday April 22,2013 - May 16, 2013

Second Requested Date in d/m/y format d/m/y format

Second Choice Day of the Week

Second Choice of Time


	Third Choice for clinic:

List alternate Dates that would work d/m/y format

Third Choice Day of the Week

Third Choice of Time


	Fourth Choice for clinic:

List alternate Dates that would work d/m/y format

Fourth Choice of Time

Fourth Choice Day of the Week


	Comments: Explain in Detail what you would like.


	NOTE: Remember that Requesting a clinic date is only a request until you receive a confirmation from the TYSL Clinic Scheduler that your request has been granted.