ILDERTON MINOR
HOCKEY REGISTRATION - 2001
NAME BIRTHDATE (Y/M/D)
ADDRESS____________________________ SEX
ADDRESS____________________________ HEALTH #
ADDRESS____________________________ TELEPHONE
POSTAL
CODE _____________ PARENTS
EMERGENCY #
----------------------------------------------------------------------------------------------------------
CHEQUES
PAYABLE TO: ILDERTON MINOR HOCKEY ASSOCIATION
FEES: TYKE (6 & UNDER) $200 PLUS SEPARATE $50
FUND RAISING FEE
OR $250 IF NOT PARTICIPATING IN FUND RAISING
SR. TYKE TO JUVENILE $275 PLUS
SEPARATE $50 FUNDRAISING FEE
OR
$325 IF NOT PARTICIPATING IN FUND RAISING
TYKE SR.
TYKE – JUVENILE
METHOD
OF PAYMENT PD IN FULL ______ ______________
POST
DATED : SEPT. ($100) ______ OCT ($100)
________ NOV ($75) _______
FUND
RAISING FEE ($50 ) ____________ LATE FEE ( $50 ) ___________
-------------------------------------------------------------------------------------------------------
COMMENTS
/ SPECIAL REQUESTS :
-------------------------------------------------------------------------------------------------------
MAIL
CHEQUE & REGISTRATION TO: BRIAN
ALLEN
C/O ILDERTON MINOR HOCKEY
12642 NINE MILE RD.
R.R. #1
ILDERTON, ONTARIO
N0M 2A0
REGISTRAR
: BRIAN ALLEN 666-1811
