Clinic Application Form

Clinic proposal

Organizer

Clinic Information [this will be use for advertisement purposes]

Clinic Type
Max. file size: 256 MB.
Max. file size: 256 MB.
MM slash DD slash YYYY
Start Time [Central Time] :
:
Face-to-Face or Online
MM slash DD slash YYYY
End Time [Central Time] :
:
This will be used to grant continuing education.
USFCA Region:
Weapons(Required)
only the number (not $ signs)
Non-members get charged 25% extra (with a minimum of $10 fee)
Do you want students (non-coach) to register for the clinic?
only the number (not $ signs)

Video your clinic

Will video recording of presentations be a part of your clinic?

Clinic Certifications

Will you be giving certification practical exams at this clinic?