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P. O. Box 1481, moncton, nb, E1C 8T6 1(888)421-0000 fax: 1(506)854-8200 bmo centre Halifax, Nova Scotia March 17 & 18, 2016 Registration Form
| REGISTRATION FORM
Please complete and mail or fax application form to:
ATLANTIC HOCKEY GROUP, P.O. BOX 1481, MONCTON, NB, E1C 8T6
1(888)421-0000 fax: 1(506)854-8200
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BMO Centre
Halifax, Nova Scotia
March 17 & 18, 2016
Registration Form
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Please indicate below team & coach
Team Name: ______________________________________________
Coaches name: ________________________________________________
Coaches contact number : ________________________________________
Email : _______________________________________________________
DIVISION : ___________________________________________________
LEVEL : ______________________________________________________
Please make cheque payable to: Atlantic Hockey Group
VISA: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Master Card: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
AMEX: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiry Date: ____ / ____
Cardholder name: ___________________________________ (please print)
Cardholder signature: ___________________________________
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Registration Fee: $500.00
fax # 506.854.8200
Atlantic Hockey Group
12 Fifth street
Moncton, NB E1E 3G9
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