First Name      Last Name

Birth Date (mm/dd/yyyy)                    Male Female

Address

City      State      Zip

Phone           E-Mail Address

 

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Deluxe Package        Standard Package        Economy Package
(1 on 1 Training)              (Group of 2-3)                   (Group of 4-8)         

 

Dates Requested in attending CueSport College:    

- to -

(mm/dd/yyyy)

 

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Estimated Current Skill Level:

Skill Level I wish to obtain:

Past Instructors or influences:

My Strong points seem to be:

My Weak points seem to be:

Preference of Staff Instructors:

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'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