2010 SUMMER WOMENS ICE HOCKEY LEAGUE TUESDAY NIGHT APPLICATION

NAME___________________________________DATE OF BIRTH_______________

STREET________________________________CITY___________________________

STATE________ZIP____________HOME PHONE____________________________

CELL PHONE________________________WORK PHONE____________________

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THE ABOVE NAMED REGISTRANT HAS AGREED TO PAY $180.00 (BROKEN INTO 2 PAYMENTS OF $90.00)  TO PARTICIPATE IN THE HOCKEYTOWN USA, INC. WOMENS ICE HOCKEY LEAGUE.

                THIS FEE COVERS THE SUMMER SESSION OF THE 2009-2010 HOCKEY SEASON. THE LEAGUE CONSISTS OF APPROXIMATELY 10 GAMES TO BE PLAYED ON TUESDAY NIGHTS FROM  JUNE 29,  2010 THROUGH AUGUST 31, 2010. GAMES WILL BE PLAYED AT 6:30PM.  INDIVIDUALS WILL BE SELECTED AND PLACED ON TEAMS. EVERY EFFORT WILL BE MADE TO BALANCE THE TALENT LEVEL OF EACH TEAM. SHIRTS WILL BE PROVIDED BY THE LEAGUE. MAKE CHECKS PAYABLE TO HOCKEYTOWN USA AND SIGN THE LIABLILITY WAIVER ON THE BACK OF THIS APPLICATION AND SEND TO:

HOCKEYTOWN USA

         953 BROADWAY

                                                                  SAUGUS, MA 01906

APPLICANT’S SIGNATURE______________________________DATE__________

                                               FOR OFFICE USE ONLY

RECEIPT #___________________DATE_________________

AMOUNT PAID_____________________INITIALS_________

PLEASE SIGN LIABILITY WAIVER ON THE BACK