First Name First Name Last Name Last Name Address Address Postal /Zip Code Postal /Zip Code City City Province/State Province/State Phone Phone Email Address Email Address MasterCard Visa Card Number CHOOSE YOUR CONFERENCE UPS Corporate Division / /Zip Code Postal /Zip Code City City Province/State Province/State Phone Phone Email Address Email Address MasterCard Visa Card Number CHOOSE YOUR CONFERENCE UPS Corporate Division / /
Person
Provincial / Background / Elite / / /
Position
Captain / PLEASE PRINT CLEARLY PLAYER / Player / incremental fee.* Adult Street PLAYER / *Additional Player / /
ProvinceOrState
Province/State Province/State Province/State Province/State Province / /
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