Please provide the following contact information:

Name: -Required
E-Mail: -Required
Address:
City:
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Zip:
Phone Number:

Rate your desire to improve your golf game on a scale of 1 to 5, 5 being the best and highest:
Describe what you would like to learn most in a golf lesson:
Would you take more than one lesson from Cindy Miller?
Please explain your biggest challenges; example - head game or golf swing?

You can contact Cindy Miller at cindy@cindymillergolf.com.