AMHERST PEPSI CENTER SEMI - PRIVATE LESSONS
COST - $50.00 PER LESSON DATE
**6 GOALTENDERS MAXIMUM PER LESSON DATE**

PLEASE FILL IN FIRST & LAST NAMES PLUS EMAIL ADDRESS & PHONE #
TO RECEIVE AVAILABILITY & CONFIRMATION OF DATES SELECTED
Parent / Guardian Information
First Name:         Last Name:  
Email Address:         Phone    

Goaltender Information
First Name:         Last Name:  
Date of Birth (mm/dd/yyyy):
                                        SEPTEMBER                                  OCTOBER
                           09/09/2009 @ 4:30pm                 10/02/2009 @ 4:00pm
                           09/11/2009 @ 4:30pm                 10/05/2009 @ 4:30pm
                           09/14/2009 @ 4:30pm                 10/07/2009 @ 4:30pm
                           09/16/2009 @ 4:30pm                 10/09/2009 @ 4:00pm
                           09/18/2009 @ 4:00pm                 10/12/2009 @ 4:30pm
                           09/21/2009 @ 4:30pm                 10/14/2009 @ 4:30pm
                           09/23/2009 @ 4:30pm                 10/16/2009 @ 4:00pm
                           09/25/2009 @ 4:00pm                 10/19/2009 @ 4:30pm
                           09/28/2009 @ 4:30pm                 10/21/2009 @ 4:30pm
                           09/30/2009 @ 4:30pm                 10/23/2009 @ 4:00pm
                                                                                                      10/26/2009 @ 4:00pm
                                                                                                      10/28/2009 @ 4:00pm
                                                                                                      10/30/2009 @ 4:00pm

CLICK "SEND BUTTON" TO SEND DATES SELECTED FOR CONFIRMATION