~ Application Form ~

Professional Player Sponsorship Program
with Fredric Fechter

 

First Name Last Name
Birth Date Male Female
Address

City State Zip

Home Phone Cell Phone Pager
Work Phone Fax
Dates Requested in attending CueSport College: to

Sports/Disciplines/Activities you enjoy:

Current Expertise of Sports/Disciplines/Activities:

Expertise you wish to obtain:

Past Teachers or Instructors:

History of Self-Teaching Methods:

I feel my strong points are:

I feel my weak points are:

I am enrolling because...

***** Method of Payment *****

Payment Option #1                          Payment Option #2

Angels Confidential                       Prevent Child Abuse

Please mail completed application form at address below to be contacted for acceptance and receive necessary donated costs.

Fredric Fechter

RR 3 Box 380

Hanna City, IL 61536

Thank You!