2009 REGISTRATION FORM

2009 REGISTRATION FORM

This form is for non-secure fax-only or postal mail registration.

Click Here for a SECURE on-line registration form.

Select the type of registration you want
Single Clinic-Individual	Single Clinic-Staff	Season Pass-Individual	Season Pass-Staff

For Season Pass registration, check all clinics you wish to attend.

Pre-Registration Prices

Which Clinic(s) are you registering for?
Check all clinics you plan to attend Single Clinic Season Pass
Can attend any or all clinics
Includes Glazier Clinic Online Pre-registration Deadline

Individual Staff Individual Staff

Season Pass Upgrade   N/A N/A $100.00 Call Us

** Atlanta, GA Extreme...Feb 27-Mar 1 2009   $85.00 $529.00 $200.00 $650.00 10-Feb-2009

** Atlanta, GA Galleria...Feb 6-8 2009   $110.00 $545.00 $200.00 $650.00 22-Jan-2009

** Baltimore, MD...Feb 6-8 2009   $110.00 $545.00 $200.00 $650.00 23-Jan-2009

** Boston, MA...Feb 12-14 2009   $110.00 $345.00 $200.00 $650.00 26-Jan-2009

** Charlotte, NC...Feb 19-21 2009   $110.00 $545.00 $200.00 $650.00 2-Feb-2009

** Cherry Hill, NJ MEGA...Feb 19-21 2009   $98.00 $395.00 $200.00 $650.00 3-Feb-2009

** Chicago, IL Glazier...Mar 6-8 2009   $110.00 $545.00 $200.00 $650.00 18-Feb-2009

** Chicago, IL MEGA...Feb 5-7 2009   $98.00 $395.00 $200.00 $650.00 20-Jan-2009

** Cincinnati, OH...Feb 19-21 2009   $110.00 $545.00 $200.00 $650.00 4-Feb-2009

** Cleveland, OH...Mar 5-7 2009   $110.00 $395.00 $200.00 $650.00 17-Feb-2009

** Costa Mesa, CA...Mar 6-8 2009   $110.00 $545.00 $200.00 $650.00 19-Feb-2009

** Dallas, TX...Feb 20-22 2009   $110.00 $345.00 $200.00 $650.00 5-Feb-2009

** Denver, CO...Feb 13-15 2009   $110.00 $545.00 $200.00 $650.00 29-Jan-2009

** Destin, FL...Feb 13-15, 2009   $110.00 $345.00 $200.00 $650.00 29-Jan-2009

** Grand Rapids, MI...Feb 19-21 2009   $110.00 $545.00 $200.00 $650.00 4-Feb-2009

** Green Bay, WI...Feb 27-Mar 1 2009   $110.00 $345.00 $200.00 $650.00 10-Feb-2009

** Harrisburg, PA SVS...Mar 12-14 2009   $80.00 $395.00 $200.00 $650.00 23-Feb-2009

** Houston, TX...Feb 26-28 2009   $110.00 $545.00 $200.00 $650.00 9-Feb-2009

** Indianapolis, IN...Feb 26-28 2009   $110.00 $545.00 $200.00 $650.00 9-Feb-2009

** Kansas City, MO...Feb 12-14 2009   $110.00 $545.00 $200.00 $650.00 27-Jan-2009

** Las Vegas, NV...Feb 5-7 2009   $110.00 $345.00 $200.00 $650.00 21-Jan-2009

** Minneapolis, MN...Feb 20-22 2009   $110.00 $545.00 $200.00 $650.00 5-Feb-2009

** Nashville, TN...Feb 13-15 2009   $110.00 $345.00 $200.00 $650.00 30-Jan-2009

** Phoenix, AZ...Apr 3-5 2009   $110.00 $245.00 $200.00 $650.00 18-Mar-2009

** Pittsburgh, PA...Feb 20-22 2009   $110.00 $395.00 $200.00 $650.00 6-Feb-2009

** Providence, RI...Mar 12-14 2009   $110.00 $345.00 $200.00 $650.00 24-Feb-2009

** Santa Clara, CA...Feb 27-Mar 1 2009   $110.00 $245.00 $200.00 $650.00 12-Feb-2009

** Seattle, WA...Feb 20-22 2009   $110.00 $545.00 $200.00 $650.00 6-Feb-2009

** St. Louis, MO...Feb 27-Mar 1 2009   $110.00 $545.00 $200.00 $650.00 13-Feb-2009

** Toledo, OH...Feb 12-14 2009   $110.00 $395.00 $200.00 $650.00 28-Jan-2009

** Tulsa, OK...Feb 5-7 2009   $110.00 $345.00 $200.00 $650.00 21-Jan-2009

Which Clinic(s) are you registering for? Check all clinics you plan to attend	Single Clinic	Season Pass Can attend any or all clinics Includes Glazier Clinic Online	Pre-registration Deadline
Individual	Staff	Individual	Staff
Season Pass Upgrade	N/A	N/A	$100.00	Call Us
** Atlanta, GA Extreme...Feb 27-Mar 1 2009	$85.00	$529.00	$200.00	$650.00	10-Feb-2009
** Atlanta, GA Galleria...Feb 6-8 2009	$110.00	$545.00	$200.00	$650.00	22-Jan-2009
** Baltimore, MD...Feb 6-8 2009	$110.00	$545.00	$200.00	$650.00	23-Jan-2009
** Boston, MA...Feb 12-14 2009	$110.00	$345.00	$200.00	$650.00	26-Jan-2009
** Charlotte, NC...Feb 19-21 2009	$110.00	$545.00	$200.00	$650.00	2-Feb-2009
** Cherry Hill, NJ MEGA...Feb 19-21 2009	$98.00	$395.00	$200.00	$650.00	3-Feb-2009
** Chicago, IL Glazier...Mar 6-8 2009	$110.00	$545.00	$200.00	$650.00	18-Feb-2009
** Chicago, IL MEGA...Feb 5-7 2009	$98.00	$395.00	$200.00	$650.00	20-Jan-2009
** Cincinnati, OH...Feb 19-21 2009	$110.00	$545.00	$200.00	$650.00	4-Feb-2009
** Cleveland, OH...Mar 5-7 2009	$110.00	$395.00	$200.00	$650.00	17-Feb-2009
** Costa Mesa, CA...Mar 6-8 2009	$110.00	$545.00	$200.00	$650.00	19-Feb-2009
** Dallas, TX...Feb 20-22 2009	$110.00	$345.00	$200.00	$650.00	5-Feb-2009
** Denver, CO...Feb 13-15 2009	$110.00	$545.00	$200.00	$650.00	29-Jan-2009
** Destin, FL...Feb 13-15, 2009	$110.00	$345.00	$200.00	$650.00	29-Jan-2009
** Grand Rapids, MI...Feb 19-21 2009	$110.00	$545.00	$200.00	$650.00	4-Feb-2009
** Green Bay, WI...Feb 27-Mar 1 2009	$110.00	$345.00	$200.00	$650.00	10-Feb-2009
** Harrisburg, PA SVS...Mar 12-14 2009	$80.00	$395.00	$200.00	$650.00	23-Feb-2009
** Houston, TX...Feb 26-28 2009	$110.00	$545.00	$200.00	$650.00	9-Feb-2009
** Indianapolis, IN...Feb 26-28 2009	$110.00	$545.00	$200.00	$650.00	9-Feb-2009
** Kansas City, MO...Feb 12-14 2009	$110.00	$545.00	$200.00	$650.00	27-Jan-2009
** Las Vegas, NV...Feb 5-7 2009	$110.00	$345.00	$200.00	$650.00	21-Jan-2009
** Minneapolis, MN...Feb 20-22 2009	$110.00	$545.00	$200.00	$650.00	5-Feb-2009
** Nashville, TN...Feb 13-15 2009	$110.00	$345.00	$200.00	$650.00	30-Jan-2009
** Phoenix, AZ...Apr 3-5 2009	$110.00	$245.00	$200.00	$650.00	18-Mar-2009
** Pittsburgh, PA...Feb 20-22 2009	$110.00	$395.00	$200.00	$650.00	6-Feb-2009
** Providence, RI...Mar 12-14 2009	$110.00	$345.00	$200.00	$650.00	24-Feb-2009
** Santa Clara, CA...Feb 27-Mar 1 2009	$110.00	$245.00	$200.00	$650.00	12-Feb-2009
** Seattle, WA...Feb 20-22 2009	$110.00	$545.00	$200.00	$650.00	6-Feb-2009
** St. Louis, MO...Feb 27-Mar 1 2009	$110.00	$545.00	$200.00	$650.00	13-Feb-2009
** Toledo, OH...Feb 12-14 2009	$110.00	$395.00	$200.00	$650.00	28-Jan-2009
** Tulsa, OK...Feb 5-7 2009	$110.00	$345.00	$200.00	$650.00	21-Jan-2009

** These clinics are no longer accepting on-line registrations. You must register on site.

Must be postmarked or received by the deadline for pre-registration prices. After pre-registration deadline and for onsite registrations, $10 per individual registration or $50 per staff registration has been included in the prices above. Glazier Clinics receives a commission on some hotel rooms purchased by attendees. Glazier Clinics reserves the right to refuse admittance and/or remove any individual from a clinic at its sole discretion. Badges may not be sold or transferred.

NO REFUNDS.

School Name:
*

Contact Name:
*

Address:
*

City, State, Zip: *

Daytime Phone:
* (999-999-9999)

Evening Phone:
(999-999-9999)

Fax Number:
(999-999-9999)

Email Address:
*

Billing Email Address:
*

* Entries required

Check here if you need a registration confirmation – you must include your Email Address.

PAYMENT INFORMATION:

Pay by Check. An invoice will be emailed to Billing Address.
Purchase order, PO#:
Pay by Credit Card

Check one: VISA MASTERCARD DISCOVER

Name on card:

Billing address:

Billing city, state, zip:
, ,

Card Number (16 digits):

Sec. code:

Exp. date:

Signature:

Amount:
(Numbers only)

PLEASE PHOTOCOPY AND WRITE ON FOR ADDITIONAL COACHES

Name(s) of Coaches you are Purchasing a Registration for (#1 being Primary Contact):

Coach Name

1.

2.

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Athletic Director Name	Phone

Courtesy of Riddell, youth coaches attend free. Please enter your local youth league president's name and phone.

President's Name	Phone

Comments:

SEND OR FAX FORM TO:

Frank Glazier Clinics / MEGA CLINIC
P.O. Box 63673
Colorado Springs, CO 80962-3673
(888) 755-6427 or (719) 536-0069
FAX (719) 536-0073

School Name:	*
Contact Name:	*
Address:	*
City, State, Zip:	*
Daytime Phone:	* (999-999-9999)
Evening Phone:	(999-999-9999)
Fax Number:	(999-999-9999)
Email Address:	*
Billing Email Address:	*
	* Entries required

Name on card:
Billing address:
Billing city, state, zip:	, ,
Card Number (16 digits):		Sec. code:
Exp. date:
Signature:		Amount:	(Numbers only)

	Coach Name
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