2008 EYSA COACH CLINIC REGISTRATION FORM

Name:                                                       Phone Day:                                                            

Phone Eve:                       Fax:                             Email:                                                           

Address:                                                                                                                                 

City, State, Zip:                                                                                                   DOB:           

Association:                      Club:                                Team Name/Age:                                      

I currently have a ______ license, obtained ______________ (date)

*Please confirm exact dates by visiting our website on a regular basis – www.eysa.org.

MAKE CHECKS PAYABLE TO “EYSA” AND MAIL ALONG WITH APPLICATION AND COPY OF YOUR CURRENT LICENSE (if applicable) TO: EYSA,  c/o Tiffany Ottopal, 22142 SE 277^th St. , Maple Valley , WA   98038   

Registration is not complete until both the application and check have been received.  You will receive confirmation by mail or email, with directions to the clinic location and any other instructions at least one week prior to clinic.  Space is limited therefore registration information must be post marked 10 days prior to clinic date to ensure time for processing and timely confirmation.  Additional forms can be downloaded from our website, www.eysa.org.

EYSA coaches will have their check voided for the amount paid upon successful completion of the clinic.  Should an applicant need to cancel their reservation less than 2 weeks prior to the clinic, they will not receive a refund.  If EYSA cancels the clinic, all coaches will receive a refund.  No shows will not receive a refund.

All questions should be directed to Tiffany Ottopal (425.681.6341) between the hours of 10AM – 8PM.

Form last revised 6/7/2008.