2015 ATLANTIC CUP
TEAM REGISTRATION FORM
August 1-August 2, 2015
Team Name: ______________________________
Team Manager: ______________________________
Address: ____________________________________________
City: __________________ Postal Code: ______________
Telephone: (H) _________________ (W) ________________ (C) __________________
Email: __________________________________ Fax: ____________________
Uniform / Sock Color: _____________________________
Players: (Maximum 18 Players)
1. 10.
2. 11.
3. 12.
4. 13.
5. 14.
6. 15.
7. 16.
8. 17.
9. 18.
Division: Open [ ] Junior [ ]
Fees: $ 550.00 Late fee: $ 575.00
Cheque payable to: Field Hockey Nova Scotia Due by 19 July 2013
Payment
Signature: _______________________________
Please send to: Jean-Pierre Brien
6131 Charles St.
Halifax, Nova Scotia
B3K 1L2
902-488-8665 (W) 902-307-0238
Email: jean.pierre.brien@gmail.com
PLEASE NOTE: Once registration has been received, teams will be subjected to a $100.00 non-refundable administration fee should they cancel their attendance before July 25th. Registration fees cannot be refunded to teams cancelling after July 26th.
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