2012 Glazier Clinic Online
Youth Scholarship Registration

Please complete every field below and click "Submit" on the bottom on the page. You will receive an email with instructions on how to access your Glazier Clinic Online Scholarship.

Youth League Information

Youth Organization League Name:*

Youth Organization Team Name:*

Youth Organization President Name:*

Youth President or Organization Email Address:*

Youth President or Organization Confirm Email Address:

Youth Organization Country:

Youth Organization Street Address:*

Youth Organization City:*

Youth Organization State/Province:

Youth Organization Zip Code:*

Personal Account Information

First Name:*

Last Name:*

Email Address:*

Confirm Email Address:*

Password:*

Password Confirmation:*

Country:

Street Address:*

Street Address 2:

City:*

State/Province:

Zip:*

Coaching Information

Coaching Level:*

Primary Coaching Area:*

Secondary Coaching Area:*

Terms and Conditions

I understand that the Glazier Clinic Online Scholarship in only available to coaches who do not coach at a school.

I understand the High School and Junior high volunteer coaches are not eligible under the rules of this scholarship program.

I understand that if I coach at a youth program and also coach at a school program, I am not eligible.

I agree that Glazier Clinics will be damaged if I use the Glazier Clinic Online scholarship under false pretenses.

I agree to pay $500 plus legal/recovery costs if I use this scholarship under false pretenses.

I understand that if I enroll in this scholarship program under false pretenses, an ethics complaint will be filed with my school.

I confirm that I do not have an affiliation with any high school or college program.

2012 Glazier Clinic Online Youth Scholarship Registration

Youth League Information

Personal Account Information

Coaching Information

Terms and Conditions

Partners

2012 Glazier Clinic Online
Youth Scholarship Registration