Jeff Shirk Lacrosse Camps

Jeff Shirk's Positional Lacrosse Clinics at the
Virginia Military Institute

January 20, 2008

Online Registration Form

Please complete the following form to register for the 2008 Jeff Shirk Lacrosse Clinic at VMI. Information on how to make a payment will be provided once you click "Submit Form" below.

Registration Form

Please provide the following contact information:

First Name

Last Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Home Phone

E-mail* (required)

*Email will be the primary method of communication. Please use the parent/guardian's email address.

Parent/Guardian Name(s)

Please select which clinic you will attend:

Attack/Defense Clinic - January 20 (9am - 12pm)
Middie/Goalie Clinic - January 20 (1pm - 4pm)

Select your position:

Age:

Grade:

Number of years playing:

Emergency Contact Name:

Emergency Contact Phone Number:

Insurance Company:

Policy Number

Allergies/Medical Conditions:

How did you hear about this clinic?

Jeff Shirk Lacrosse Camps
P.O. Box 577
Lexington, VA 24450
(540) 908-2152

Jeff Shirk Lacrosse Camps

Dedicated to Helping Lacrosse Players Realize, Develop, and Achieve Their Goals

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