| Personal Information * required fields |
| *Full Name: |
Company: |
*Age |
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| Hockey Position: |
Height: |
Weight: |
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| Address: |
City: |
Province/State: |
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| Postal Code : |
Country: |
*Home Phone: |
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| Cell Phone: |
Work Phone: |
*Email Address: |
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| Emergency Information |
| *Name: |
Address: |
*Home Phone : |
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| Work Phone: |
Cell Phone: |
*Email Address: |
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| Health Insurance Number: |
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| Equipment |
| *Hockey Pants: |
*Golf Shirt: |
*Underwear: |
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| *Sticks: |
*Hockey Sweater: |
*Skill Level: |
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| *What name and number would you like on your sweater? |
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| Questions & Comments |
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| Other Information |
After March30th 2008 the cost of this unique opportunity is $4995.00 (CDN) plus 5% GST and includes lake side accommodation, meals, and ice-time.
A non-refundable deposit of $2000.00 (CDN) must accompany all applications.
Single room occupancy is available for $500.00, subject to availability.
Balance of payment is due upon arrival.
Click here to print PDF of form
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