Request for LA84 Foundation Coaching Clinic
COACHING EDUCATION REQUEST FORM
Please complete this form online
Fields with * are required
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Today's Date
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Your Name:
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Organization:
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Phone Number (work):
Phone Number (cell):
Phone Number (home):
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E-mail Address:
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Re-type your email address
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Is your organization an LA84 Foundation Grantee:
Yes
No
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What type of coaching clinic are you requesting?
Selection one or more options below
Art of Coaching Clinic
Other
OTHER, Please Specify:
- Please tell us when and where you want the clinic.
- We can send an instructor to your facility in Southern California, or your coaches can come to the LA84 Foundation. It's your choice.
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What
day?
Please list your first and second choices.
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Starting Time:
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Where?
Include street address, room and/or room number if appropriate:
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How many coaches will attend?
If you are not an LA84 Foundation grantee, you must have at least 10 coaches for a clinic.
Do you have any special requests or questions?
We will contact you within one business day.
If you wish commnicate with the LA84 Foundation about the clinics, contact either or both individuals below:
Wayne Wilson (323)730-4640
wwilson@la84foundation.org
Michael Salmon (323)730-4641
msalmon@la84foundation.org
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Indicates Response Required