CLUBMAX COACHING: Club Application Form

  
 
Club Membership Includes: Practice Plans, Video Training, Game Day Guides,
The Tryout Center, Online Player Evaluations and the Coach's Forum
 

Club Membership:

For only $495 per year, all coaches, assistant coaches, players, parents and administrators will have access to the ClubMax Website.
 
Contact Information
Soccer Club Name:
Club Contact Name:
Address:

City:
State:
Zip:
Email:  
Daytime Phone:
Evening Phone:
     
Choose an Option
    
Club Membership ($495 per year)

Choose a User Name and Password for Administrators
Administrator User Name:
Administrator Password:
     

Choose a User Name and Password for Coaches
Coaches User Name:
Coaches Password:
 

Choose a User Name and Password for Players
Players User Name  
Players Password  
 
Please select your preferred form of payment
By Check

I am submitting this form electronicaally and will mail a check payable to ClubMax Coaching to 58 hawks Hill Road, New Canaan, CT 06840. I understand my access with be initiated upon receipt of the check.
 
Amount I am sending by mail:
 
Check Number:
 
Date Check Sent:
 
By Charge
 
Account number on card:
Expiration date on card:

Name as it appears on your card:

  
 

Please note: All online information from this form is handled by a secure server.
   
 

Upon subscribing, ClubMax Coaching™ will contact you directly to confirm your subscription.
 

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For more information call us at 203.966.8081
or email ClubMax™ Coaching now at
davejohnson@clubmaxcoaching.com

© 2005 Five Star Holdings, LLC

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