NLVA Certification Clinic Registration Form

Please complete ALL fields of the following form. Once you click "SUBMIT FORM" at the bottom of the page, your application will be reviewed by the NLVA.

If you have any questions, please feel free to contact the NLVA at (709) 576-0817 or through email at nlvaruss@sportnl.ca.

Available Clinics
Name:
 
Address 1:
Address 2:
City/Town:
Province:
Postal Code:
 
Email:
Phone # (h):
Phone # (w):
Fax #:
Gender:
Male
Female
Coaching Experience:
Method of Fee Payment:
PayPal (Credit Card Online)
Cheque/Money Order in Mail
 

::Site best viewed with 800x600 resolution or higher::