Student Enrollment Application Form

First Name      Last Name

Birth Date (mm/dd/yyyy)                    Male Female

Address

City      State      Zip

Phone           E-Mail Address

How did you find CueSport College? (Professional/Student referral, Search Engine, Internet Ad (Facebook or Sponsor Website), Other)

 

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Deluxe Package        Standard Package        Economy Package
(1 on 1 Training)              (Group of 2-3)                   (Group of 4-8)         

 

Dates Requested in attending CueSport College:    

- to -

(mm/dd/yyyy)

 

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- We appreciate any information below to better serve you, but all fields are optional. -

 

When did you start playing pool: (optional)

Past Instructors and/or influences: (optional)

My accomplishments in the game thus far: (optional)

My studies and practices in pool are: (optional)

My Strong points seem to be: (optional)

My near and distant goals in my game are: (optional)

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'A paid deposit is required to reserve all accepted applicants tentative enrollment dates'

*** For your convenience we accept all major credit cards ***

 

* Please expect our follow up telephone call to confirm enrollment acceptance *

 

 

Thank you!

CueSport College International

325 S. Bellevue Ave.

Peoria, IL 61604

(309) 697-2774