Contact Us
Ice Breaker Tournament Registration Form
Updated July 16/04
Team Name:
Team Contact:
Address:
City:
Province:
Postal Code:
Home Phone:
Work Phone:
Fax:
Cellular:
Email:
**Required
Team Colors (Home):
Team Colors (Away):
Coach:
Phone/Fax:
Assistant Coach:
Phone/Fax:
Manager:
Phone/Fax:
No. of Team Members:
Division:
Midget AAA/AA
Bantam AAA/AA
Senior AA
Senior Recreational Level A
Senior Open Rec Level A
Senior Open Rec Level C
Midget A
Bantam A
Senior A
Senior Recreational Level B
Senior Open Rec Level B
ENTRY FEE: $700.00 ($750.00 after October 20th)
Pay in full at time of registration and each team member is eligible for a draw for a free accommodation and meal package from The Hilton Vancouver Metrotown
CHEQUE PAYABLE TO :
C.I.F.I.H.S
P.O.BOX 34038
CLOVER SQUARE VILLAGE, 17790 #10 HWY.
SURREY,BC V3S 8C4
PH: 604-.574-9843 FAX: 604-576-0763 E-MAIL:
info@centre-ice.com
DEPOSIT OF $375.00 MUST ACCCOMPANY REGISTRATION TO HOLD SPOT
DEADLINE FOR PAYMENT: October 20th, 2004
