TEAM ENTRY FORM:
Team Name:	* required
Division Entered (choose only one):	Competitive Over 35 Over 50 Women Family Non-competitive Age 10-12
Team Captain Name:	* required
Date of Birth: (day, month, year)	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day January February March April May June July August September October November December Month  * required Year  * required Age on February 3, 2012
E-mail:	* required
Mailing address:
Phone: Fax:	* required include area code include area code
Player 2 Name:	* required
Date of Birth: (day, month, year)	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day January February March April May June July August September October November December Month  * required Year  * required Age on February 3, 2012
E-mail:
Mailing address:
Phone: Fax:	include area code include area code
Player 3 Name:	* required
Date of Birth: (day, month, year)	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day January February March April May June July August September October November December Month  * required Year  * required Age on February 3, 2012
E-mail:
Mailing address:
Phone: Fax:	include area code include area code
Player 4 Name:	* required
Date of Birth: (day, month, year)	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day January February March April May June July August September October November December Month  * required Year  * required Age on February 3, 2012
E-mail:
Mailing address:
Phone: Fax:	include area code include area code
Player 5 Name (Over 50 Division Only)
Date of  Birth: (day, month, year)	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day January February March April May June July August Setpember October November December Month Year Age on February 3, 2012
Email:
Mailing address:
Phone:   Fax:	include area code include area code
	How did you hear about the tournament?  Choose the most appropriate. Played in previous year(s) 99.3 The River Life Radio Miramichi Leader Moncton Times Brochure Poster Rotarian Email Website Search Engine Friend Facebook Twitter
	Would you be willing to referee games in another division? Yes No

Pond Hockey Team Registration - choose below New Registered Teams $320.00 50+ Division with 5 Players $400.00 Enter team name exactly as submitted on the registration form. Or Send Cheque To:   Rotary Club of Newcastle P.O. Box 433 Miramichi, New Brunswick, Canada E1V 3M5

Paying Online 1. Complete the Registration Form above and submit 2. Choose your division from the drop-down menu on the left. 3. Enter in your team name exactly as it was submitted on the registration form above and click the BUY NOW button. Don't Have a PayPal Account? Thats Okay! When you login you'll be given the option to pay by credit card or use your paypal account. See example below. click to enlarge