Registration FRANCIS WATHIER HOCKEY ACADEMY SUMMER 2010
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indicates required fields
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PRENOM/FIRST NAME:
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NOM/LAST NAME:
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ADRESSE:
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VILLE / TOWN:
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CODE POSTAL / POSTAL CODE:
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ADRESSE COURRIEL/ EMAIL:
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NUMERO DE TELEPHONE / PHONE NUMBER:
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AGE / DATE DE NAISSANCE /D.O.B:
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POSITION:
NUMERO DE CHANDAL (3CHOIX DE PREFERENCES) JERSEY #:
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NIVEAU JOUEUR/LEVEL PLAYING:
CHOISIR/CHOOSE
NOVICE
ATOME
PEE-WEE
BANTAM
MIDGET MINOR
MIDGET MAJOR
JUNIOR B',C'
JUNIOR A'
OHL/LJMHQ/COLLEGE
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GRANDEUR CHANDAIL/JERSEY SIZE:
YSMALL
YMEDIUM
YLARGE
SMALL
MEDIUM
LARGE
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GRANDEUR T-SHIRT SIZE:
YSMALL
YMEDIUM
YLARGE
SMALL
MEDIUM
LARGE
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NOM DU PARENT OU TUTEUR/ PARENT NAME:
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PACKAGE:
CHOISIR/CHOOSE
NOVICE/ATOME/PEEWEE/BANTAM
''STARS COMBO''- DRYLAND+HOCKEY CAMP = 890$(incl.taxes)
HOCKEY CAMP- 650$ (incl.taxes)
DRYLAND- 290$ (incl.taxes)
1------------------------------1
MIDGET/JUNIOR
''NHLers IN TRAINING''- DRYLAND+ON ICE TRAINING- 1,115$(incl.taxes)
ON-ICE TRAINING- 745$(incl.taxes)
DRYLAND- 420$(incl.taxes)
DRYLAND CHOOSE TIME (NOVICE,ATOME,PEEWEE,BANTAM):
ONLY FOR DRYLAND SESSION
6:00pm-7:15pm
7:15pm-8:30pm
GROUPE HOCKEY GROUP:
CHOISIR/CHOOSE
NOVICE
ATOME
PEE-WEE
BANTAM
MIDGET MINOR
MIDGET MAJOR
JUNIOR/COLLEGE/OHL/LJMHQ
*APPUYER SUR LE BOUTON ''SUBMIT
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ENVOYER VOTRE PAIEMENT A:
FRANCIS WATHIER HOCKEY ACADEMY
C.P 467
CASSELMAN, ONTARIO
K0A 1MO
VOTRE PLACE SERA RESERVER POUR LES PROCHAINS 72HRS!
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