Speed, Quickness and Conditioning Camp Registration Form: Dallas, TX Location-2 week intensive camp

Please provide the following registration information:

Name
Address
City
State
Zip
Title, Coaching Position, or Sport Position
Organization, High School, or College
Age
Grade
Past Injuries
Medical Conditions
Have you had a physical?	Yes No
Allergies
Work Phone
Home Phone
Primary Sport	Football Basketball Soccer Field Hockey Track and Field Softball Baseball Hockey Volleyball Lacrosse
Secondary Sport	Football Basketball Soccer Field Hockey Track and Field Softball Baseball Hockey Volleyball Lacrosse
Other information or individual training requests
Sport interested in developing speed for:	Football Basketball Soccer Field Hockey Track and Field Softball Baseball Hockey Volleyball Lacrosse
E-mail
Preferred Location (please check)	Dallas, TXRegion: for the 2 week intensive 5 days a week camp (10 sessions)-$135.00 Dallas, TX Region: for the 2 week intensive 5 days a week camp (6 sessions you choose the days)-$110.00
If you checked above, please write in the six session days you are going to attend
Choose the Camp and The Dates You Will Be Attending:	DATES:  2 week intensive 5 days a week camp:  November 10-22
Time Slots Available (please choose your preference) Choose two slots	5pm-6pm 6pm-7pm

Please provide choose the camp that best suits you:

# of Athletes	Amount	Camp
	$135 per person
	$110.00 per person
Payment Information
In order to secure your spot you must pay the $60 deposit. (spots are filling up fast). We will charge you for the deposit if you pay by credit card and we will not charge the full amount till the week before the camp starts. If you want to pay by check please send check to: Schuman's Speed Center, 49 Finnigan Ave. Q-3, Saddle Brook, NJ 07663
Type:	Visa Mastercard	Credit Card #
Name On Card
Address
Expiration Date	Month: January February March April May June July August September October November December Year: 2003 2004 2005 2006 2007 2008 2009 2010
	Pay Deposit Now	Pay Full Amount

Please fill out the form and we will contact you to set you up with the appropriate camp for your sport. If you want individualized person speed training please indicate and we will arrange that for you as well. You can fill out this form and mail your check for the appropriate amount to: Schuman's Speed Center, 49 Finnigan Ave. Suite Q-3, Saddle Brook, NJ 07663. Remember for the 2 week intensive 5 days a week camp-$135.00 or $110.00 for 6 session version.

The $60 deposit is non refundable and assures you a place in our camp

Questions? Call us at 201-587-0965 or email us at schumanspeed@aol.com