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To pay by Credit Card, Please Call Clay @ (210) 410-4114

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NAME: _______________________________________    NAME: _____________________________________

                                                                                                      
NAME: _______________________________________    NAME: _____________________________________


SCHOOL: ______________________________________ SCHOOL PHONE: ___________________________

 
ADDRESS: _______________________________________   CITY:_________________________

STATE:_____________________                        ZIP: _________________________

 
EMAIL ADDRESS:  ___________________________________________________________________                                                            

To pay by Credit Card, Call (210)410-4114, or "Contact Us" and we will call you to get information

Enclosed is a check for $________ covering coaches at $70 per coach. ($85 after February 1st,

no refunds after this date)

***$250 for the Entire Staff***

Please note the NEW Address:

Make Checks to: Best Little Clinic in Texas / 16440 State Hwy 71, Pontotoc, Tx. 76869


For more information, contact your clinic directors:

Clay Bode                 Zane Bode               Lance Moffett            Alan Haire
(210)410-4114           (254)541-1096           (512)733-4186            (512)517-6112

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