Organization/Team/League Name: * Contact Name * First Name Last Name Email * Phone * (###) ### #### Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Clinic Information Clinic Held: * Monday Tuesday Wednesday Thursday Friday Saturday Sunday Clinic Date(s) * We want Michele for the ENTIRE CLINIC We want Michele for SPECIFIC DATE(s) Type of Clinic: * Physical Location: * Address 1 Address 2 City State/Province Zip/Postal Code Country Experience/Skill Level: * Clinic Start Time: * Hour Minute Second AM PM Clinic End Time: * Hour Minute Second AM PM Arrival Time: * Hour Minute Second AM PM Departure Time: * Hour Minute Second AM PM Select * Whole-Group Small-Group Break-Out Sessions Whole-Group Duration of Clinic Instruction (minutes): Number of Whole-Group Participants: Small-Group Break-Out Sessions Number of Sessions Per Day: Duration of Each Session: Number of Participants per Session: Clinic Goals: List the general goals/outcomes of the clinic and/or break-out sessions. Will there be a Q&A session during the clinic? * Yes No Date and Time: Will there be a meet-and-greet session? Yes No Date and Time: Thank you!
