2008 INDIVIDUAL REGISTRATION FORM

Please complete the registration form below

For information about what is included Click Here

Team Registration please Click Here

Questions or Concerns? Please call (902) 431 7713

Personal Information

FIRST NAME

LAST NAME

GUARDIAN if under 18 years old

HOME ADDRESS

APT

CITY

PROV

POSTAL CODE

HOME PHONE

WORK PHONE

ext 

EMAIL

DATE OF BIRTH

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 19

HEIGHT

4' 5' 6' / 0" 1" 2" 3" 4" 5" 6" 7" 8" 9" 10" 11"  

WEIGHT

Below 80 lbs. 81 - 100 lbs. 101 - 120 lbs. 121 - 140 lbs. 141 - 160 lbs. 161 - 180 lbs. 181 - 200 lbs Above 200 lbs.

PLAYING Preferences

LEAGUE

  Men's LEAGUE   WOMEN'S LEAGUE

POSITIONS all that apply

  Forward   Defense   Goalie    

desired division

Division 1 - Elite Division 2 - Advanced Division 3 - Average

ICE HOCKEY EXPERIENCE

AAA   AA   A   House League

TEAMMATE REQUESTS

Payment

$200  If paid in full on or before first regular season game

$220  If paid in full on or before third regular season game

  Cash AT ARENA

  Cheque  Mailing Address

Additional Information

COMMENTS

Where did you hear about us?   Web Site Newspaper Ad Mooseheads Calendar Other Advertisement Friend Other

For further information please call (902) 431 7713