GAME READY Multi Day Soccer Clinic Mount Gambier
BLUE LAKE SPORTS PARK Registration form
Personal Information
Person Responsible for the child
Parent/Caregiver Name
*
First Name
Last Name
Email
*
example@example.com
Age Group
*
9-11 Year Old
12-14 Year Old
Select Day:
Monday Oct 5 (9:30am - 2:00pm)
Tuesday Oct 6 (9:30am - 2:00pm)
Both Days (9:30am - 2:00pm)
Player details
*
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
Back
Next
My Products - 9:30 - 2:00pm
*
prev
next
( X )
Day attending
Please select
$150.00 AUD
$
150.00
AUD
Quantity
Price
Both Days
1
2
3
4
$150.00 AUD
$
150.00
AUD
Single Day
1
2
3
4
$75.00 AUD
$
75.00
AUD
Item subtotal:
$0.00 AUD
$
0.00
AUD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit registration
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