Tuesday, January 16, 2018
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Our website is NOT compatible with Internet Explorer 10 or 11. If you do not see a list of page links on the left (below), please change to compatibility view now. To enable compatibility view read here: http://windows.microsoft.com/use-compatibility-view#ie=ie-10-win-7  or click the Compatibility View button icon at the end of the address bar.

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 Register Online
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Payment via Credit Card is at the Bottom of page

Click here to print this application.

Mark Mirabelli Track & Field Clinic LLC
Clinic Application

  I wish to enroll my son/daughter in the 2018 Mark Mirabelli Track & Field “Learn by Doing"Clinic. I understand that neither Toms River School District, John Bennett Indoor Athletic Center on 1519 Hooper Ave., Toms River NJ 08753 the director, nor anyone connected with the Mark Mirabelli Clinic will assume any responsibility for accidents, medical, dental or other expenses incurred as result of accidents sustained during or as a result of any course of instruction given the applicant by the clinic staff. I hereby authorize the guardian, coach, director to act on my behalf according to his/her best judgment in any emergency requiring medical attention.

Signature of Parent ____________________________     School______________________ ____________________________

Applicant's Name _____________________________     Age ____     Male ____     Female ____

Street Address _____________________________      City _____________________________

State _________     Zip Code _________     Home Phone ___________________________

Event ______________________________________________ Grade__________  

Email Address ______________________________________________

 

Please  fill out application and return it with a non- refundable registration fee of $85.
Registration at the door will be $95.
Discounted team rate of $650 for maximum of ten athletes from one team. A savings of $200!
(Coaches not included)
Payment entitles you to attend all eight sessions. 

Or if you would like to pay via credit card please use the paypal links at the bottom of this page.

Return to:
Mark Mirabelli
9 Exeter Court
Lumberton, NJ 08048

Make checks payable to: Mark Mirabelli

For more info call: 609-267-4810
email:
mark@mmtrackandfield.com


NOTES
_________________________________
  • Handouts covering session topics will be available
  • Bring indoor shots, discus, and javelins.
  • Lunch: bring your own sandwich snacks and drinks will be available for sale
  • All presentations are interactive. Participants are expected to wear comfortable workout gear.
  • Door prizes will be raffled off between sessions.
  • Due to unforeseen emergency, clinicians may change.
  • Clinic T-Shirts will be on sale for $10
  • The "Mark Mirabelli Throwing Series" will be on sale for a $5.00 discount.
 Team Registration
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Cost:                $   650.00
Handling Fee:     $   19.25
Total:                $669.25

On the Paypal Checkout Please be sure to include your contact information and up to 10 Team Members & Event. By clicking on the Paypal Link you are "signing the form".

Make payments with PayPal - it's fast, free and secure!

Cost:                $   650.00
Handling Fee:     $   19.25
Total:                $669.25

On the Paypal Checkout Please be sure to include your contact information and up to 10 Team Members & Event. By clicking on the Paypal Link you are "signing the form".

Make payments with PayPal - it's fast, free and secure!

 Individual Registration
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Cost:                $   85.00
Handling Fee:     $    2.77
Total:                 $87.77

On the Paypal Checkout Please be sure to include your contact information and event. By clicking on the Paypal Link you are "signing the form".

Make payments with PayPal - it's fast, free and secure!

Cost:                $   85.00
Handling Fee:     $    2.77
Total:                 $87.77

On the Paypal Checkout Please be sure to include your contact information and event. By clicking on the Paypal Link you are "signing the form".

Make payments with PayPal - it's fast, free and secure!

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