Ice Cane Tournament
November 12 2009
Ice Cane Tournament – 2010REGISTRATION FORM Team Name: _________________________________ Date of Registration: _______ Contact Name: _______________________________ Phone: ___________________ Address: ____________________________________ E-mail: ___________________ City/State/Zip (States): _________________________________________________________ Canada (Providence): __________________________________________________________ Ages Division (circle one): Open (18 yrs over) 30 over 50 over*Age recorded is of January 1, 2010 (i.e. Date of Birth recorded is 12/15/1960 – age is 50) (print legibly)Player Name Age Player Name Age ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ ________________________ _____ _______________________ _____ My signature below attests to the fact that the information I have provided is true and correct to the best of my knowledge. Any player not being his or her stated age will be removed from my team. Any player fighting will be removed from the tournament without any appeal. ____________________________ Payment: ____Cash OR __ Check #________Contact Name Signature – Date Credit Card: VISA Master Card (circle one) Name on Card: ________________________________NO verbal reservations. Payment Card Number: ________________________________must be made in full to participate. Expiration Date:___________ # on back of Card:_____ First come, first serve, no exceptions. OFFICE USE ONLY:Registration Due on/before 1/28/2010 Processor Name: _________________ (signature/date)
