Atomic Pom's Fall Clinic 2022 Registration

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Registration will close on August 20th.

Team Name *

Coach's Name *

Cell Phone *

Additional Phone Number

Coach's Email *

Team Email *

Additional Contact Info

Which package will your team be purchasing? (Please refer to the attachments in the email for details on each package.) *

Personal Package 1 Routine ($275)

Personal Package 2 Routines ($450)

Personal Package 3 Routines ($625)

In Person Package Hip Hop ($275)

Check this box if you would like to attend the performance portion directly following the in person clinic, available to both package options. (+$50 to your total price)

Yes (Add $50 to your total price)

Please select which routine(s) your team has selected to learn. *

Advanced Hip-Hop

Intermediate Hip-Hop

Moderate Pom

Moderate/Conditioning Kick

Required

How many team members are participating? *

Do you have any request for Atomic members you would like your team to work with during their private instruction? (We can't guarantee we can fill all requests.) *

Will your team be purchasing Atomic Pom Clinic Tank Tops? ($17 each) If you select yes please fill in the amount of each size in the following questions.

Yes

Clear selection

How many youth small tank tops?

How many youth medium tank tops?

How many youth large tank tops?

How many adult small tank tops?

How many adult medium tank tops?

How many adult large tank tops?

How many adult extra large tank tops?

We have tank tops available in plus sizes. We also have men's sizes available. Please list below if needed. (Price may increase on both of these adjustments.)

What payment method will your team be using? (Total payment should be package amount plus the number of tank tops times $17) *

School Check (Checks are payable to Atomic Pom)

Check (Checks are payable to Atomic Pom)

Money Order (Payable to Atomic Pom)

Venmo (@AtomicPom) (This is our preferred method of payment. Also, please add team name and fall clinic in the description)

The participant acknowledges and agrees that the choreography (and all rights therein, including, without limitation, copyrights ) belongs to and shall be the sole and exclusive property of Atomic Pompon. Atomic Pompon wishes to maintain both the confidentiality of the choreography and the protection of Atomic Pompon’s intellectual property rights. Participants agree to receive information and choreography and to refrain from copying, disclosing, selling, or offering any and all of said choreography. (A Coach must E-Sign AND date below) *

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