Mississauga Steelheads Hockey Development Camp August 22nd ...

Mississauga Steelheads Hockey Development Camp August 22nd – 26th 2016 – Tomken Arena Player Information Name: ____________________________________________ Gender: M_____ F _____ Address: ________________________________________________________________ City: ____________________________________ Postal Code: ____________________ Date of Birth (DD/MM/YYYY): ________________ 2015-16 Team: _________________ Position: _________________________________ Shoots: Left ____ Right______ Parent/Guardian Information Name: __________________________________________________________________ Emergency Contact Phone #_________________________________________________ Email: __________________________________________________________________ Relation to participant: ____________________________________________________ Payment Information: $220 + HST per player _____VISA _____MasterCard ____ Cheque (payable to: Mississauga Steelheads) Card #: __________________________________________________________________ Expiry Date: ____________________ Cardholder Name: _________________________ Signature: _______________________________________________________________ Please email registration forms to [email protected] or fax to 905 502 0169. Attendance will be confirmed via email.

5500 Rose Cherry Place Mississauga ON L4Z 4B6 Tel. 905-502-7788 Fax. 905-502-0169 www.mississaugasteelheads.com