2015-2016 > Justin Williams Cup AE > Justin Williams Cup AE (Northumberland Minor Hockey)

Justin Williams Cup AE

	Thank you for entering our AE Tournament (September 11-13, 2015)
	You have two payment options. You can either pay online with a major credit card/PayPal or send a cheque for $850.00 made payable to the “Northumberland Minor Hockey Association or “NMHA” to: Northumberland Minor Hockey Association 750 D'Arcy St., Cobourg, ON K9A 0G1 If paying by cheque please add team name and division to the memo line

Payment Info

Payment Amount^*

Required

Tournament Division^*

Required

Which division are you registering for?

Payment Type^*

Credit Card / PaypalCheque

Required

Your Team Information

Team Name^*

Required

i.e Northumberland Nighthawks

Association^*

Required

i.e Northumberland Minor Hockey Association

Branch^*

Required

i.e. OMHA, Alliance, GTHL etc.

Category^*

Required

AE1, AE2, AE3-5

League^*

Required

i.e. Tri-County, York-Simcoe, GTHL etc

Jersey Colours:

NOTE: Bring both sets of jerseys to the tournament in case of colour conflicts!

Home^*

Required

Body Colour / Trim

Away^*

Required

Body Colour / Trim

Manager Contact

Note: In all cases the manager will be utilized as the primary contact. Please ensure that the person declared as manager has a functioning fax machine and e-mail address as communication is done primarily through these avenues.

Manager^*

Required

Address^*

Required

City^*

Required

Postal Code^*

Required

Home Phone^*

Required

Example: ###-###-####

Work Phone

Example: ###-###-#### x###

Email Address^*

Required

Your registration Confirmation will be sent to this address

Fax #

Example: ###-###-####

Coach Contact

Head Coach^*

Required

Address^*

Required

City^*

Required

Postal Code^*

Required

Home#^*

Required

Example: ###-###-####

Work#

Example: ###-###-#### x###

Email Address

Example: [email protected]

Fax #

Example: ###-###-####

Roster

Please add your roster if available

Goalie

Player

By checking the box below, the Team Manager on behalf of his/her team releases any sponsors of the above mentioned tournament, its officials, arena management and all concerned with the tournament, from any liability for any injury or accident which may be incurred by any players or team official while participating in, or coming to, or going from, the tournament and accepts all decisions of the tournament committee as final.

I agree to the terms and conditions stated above^*

Justin Williams Cup AE, Justin Williams Cup AE, 2015-2016 (Northumberland Minor Hockey)

Payment Info

Your Team Information

Jersey Colours:

Manager Contact

Coach Contact

Roster

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