Blizzard Invitational Sledge Hockey Tournament Registration

Contact Information

Name: *

Title:

Street Address: *

City: *

Province/State: *

Country: *

Postal/Zip Code: *

Phone: *

Cell:

Business Phone:

Email: *

Team Information

Team Name: *

Division: *

Rating:

Home Light Colour :

Away Dark Colour:

Bench Staff

Name: *

Title:

Certification Number: *

Bench Staff 2

Name:

Title:

Certification Number:

Bench Staff 3

Name:

Title:

Certification Number:

Bench Staff 4

Name:

Title:

Certification Number:

Bench Staff 5

Name:

Title:

Certification Number:

Players

Player 1

Name:

Player 2

Name:

Player 3

Name:

Player 4

Name:

Player 5

Name:

Player 6

Name:

Player 7

Name:

Player 8

Name:

Player 9

Name:

Player 10

Name:

Player 11

Name:

Jersey Number:

Player 12

Name:

Player 13

Name:

Player 14

Name:

Player 15

Name:

Player 16

Name:

Player 17

Name:

Player 18

Name:

Player 19

Name:

Player 20

Name:

As this application is accepted, it is understood and agreed that the London Blizzard Sledge Hockey Club, its directors, its members, its sponsors and their representatives, successors or heirs assume no liability for injuries, illness, damage or any other loss, however caused, as a result of participation in or traveling to/from this sledge hockey tournament and venues.

All coaches and team representatives hereby agree to and will abide by all tournament rules and regulations set forth by the Tournament Committee. All teams must provide proof of insurance coverage.

Todd Sargeant
Email: toddsargeant@hotmail.com
Home: 519-660-1705

Sigmund Bernat
Email: bernat.s@sympatico.ca
Home: 519-432-0258
Fax: 432-3281

Teams can not be accepted until fees have been paid.
Send Payment to:

London Blizzard Sledge Hockey Club
10 Pine Ridge Place
London Ontario, Canada
N5X 3G9

Office Use Only
Payment Recevied
Confirmation Sent
Email Added

By submitting this application I acknowledge I have read and understood OSHA Tournament Rules & I am very clear on the OSHA Eligibility Rules.

Blizzard Invitational Sledge Hockey Tournament Registration

Bench Staff

Players

Teams can not be accepted until fees have been paid.
Send Payment to:

Tournaments

Application Forms

CSTT Events

Blizzard Invitational Sledge Hockey Tournament Registration

Bench Staff

Players

Teams can not be accepted until fees have been paid. Send Payment to:

Tournaments

Application Forms

CSTT Events

Teams can not be accepted until fees have been paid.
Send Payment to: