CueSport International Instructor Enrollment Form  

First Name      Last Name

Birth Date (mm/dd/yyyy)                    Male Female

Address

City      State      Zip

Phone           E-Mail Address

Dates Requested in attending CueSport College       - to - (mm/dd/yyyy)

Enjoy Teaching:

(Cuesport fundamentals, Mental, Somatic, Inspirit, Nutrition, Reflexology, Isometrics, Body-building, Biofeedback, etc.)

'A confirmation paid deposit is required to reserve all tentative enrollment and/or dates'

*** For your convenience we accept all major credit cards ***

* Please expect our follow up telephone call to receive your deposit for confirmation of enrollment *

CueSport College International

325 S. Bellevue Ave.

Peoria, IL 61604

(309) 697-2774