CLUBMAX COACHING: Player Application Form

  
 
For only $39.95 per year, players will have total access to the Video Training Center. That's only $3.33 per month for professional moves demonstrated by professional youth coaches!
 
Contact Information
Soccer Club Name:
Player's First Name:
Player's Last Name:  
Parent's First Name:  
Parent's Last Name:  
Address:

City:
State:
Zip:
Email:
Daytime Phone:
Evening Phone:
     
Player Membership ($39.95 per year)

Choose a Player User and Password
Player User Name:
Player 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

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