Mississauga Reps AAA Hockey Club

September 4th, 2010

You can fill out this form on your computer, then print it out for mailing, OR you can print it, then fill it out by hand.

Shanahan International Tournament Application

General Information

Team Name:
Age Group:
Category:
District Association:

Team Contact:
Home Phone:	- -
Work Phone:	- -
Cell Phone:	- -
Fax:	- -
Email:

	Notes or Special Requests:
Do you wish to receive Hotel Accomodation Information?
	Yes No

Payment Information

Payment to be made by:

Cheque

Cost to pay by cheque is: $1175.00 CDN

Please make cheques payable to "THE REPS OF MISSISSAUGA"

Please remit payment to:
     Mississauga Reps Tournament c/o Brian Ash
     734 Glenleven Court
     Mississauga, Ontario
     Canada, L5H 1B1

*Applications will not be processed until payment is received.

Team Roster Information

	Jersey	Player	Position
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

*Team rosters do not have to be finalized until time of first game, but must be submitted at time of registration for the production of our program.

Team Staff Information

Manager:
Head Coach:
Assistant Coach:
Assistant Coach:
Trainer: