Clinic Hosting Request Form

Gyms interested in hosting are asked to consider the following facility requirements prior to submitting:

– Enough Space to facilitate course

– Tables and Chairs to Accommodate the class size.

– Accessible power for presentation tools.

– Necessary Equipment

– Uninterrupted Gym Access (no classes running simultaneously).

Clinic being requested(Required)

Club Name

Name of Contact Person

First Last

Clinic Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Where the clinic be held

Phone

Module/Level

Number of Participants confirmed

Please indicate how many participants you have interested in taking the course

Open Registration(Required)

Will you be allowing individuals outside your club to participate?

Please select the Saturday of the weekend you'd like to host. Please provide more than one weekend.

Date

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