Coaching Clinic Registration

Early Bird Registration $175 (Pre June 15th)

Standard Registration $200 (Post June 15th)

After submitting registration please do not forget to complete the payment below

Name

First Name

Last Name

Phone

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School/Club Associated With

Payment

Checks must be made out to Staples Rugby Club and mailed to:

Staples Rugby Club, P.O. Box 264, Greens Farms, Westport, CT 06838

Venmo @staplesrugbyclub