2013 WINTER WOMENS ICE HOCKEY LEAGUE WEDNESDAY NIGHT APPLICATION

NAME___________________________________DATE OF BIRTH_______________

STREET________________________________CITY___________________________

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                                    PLEASE INDICATE PREFERED POSITION

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                                                        DEFENSEMEN__________

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WOULD YOU CONSIDER YOURSELF A C OR D LEVEL PLAYER

                                                                 C__________

                                                                D__________

LIST EXPERIENCE BELOW

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THE ABOVE NAMED REGISTRANT HAS AGREED TO PAY $320.00 (BROKEN INTO 2 PAYMENTS OF $160.00) TO PARTICIPATE IN THE HOCKEYTOWN USA, INC. WOMENS ICE HOCKEY LEAGUE.

                THIS FEE COVERS THE WINTER SESSION OF THE 2012 HOCKEY SEASON. THE LEAGUE CONSISTS OF APPROXIMATELY 16 GAMES TO BE PLAYED ON WEDNESDAY NIGHTS FROM JANUARY 2^ND TO APRIL 17^TH 2013. THE GAME WILL BE PLAYED AT 8:50PM.  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 PRINT AND SIGN LIABILITY WAIVER HERE