2008-09 Fall/Winter 35 & Over
Adult Hockey League Registration Form
Please print this page, fill out all information and send to:  
ICE Arena, 5165 E. Remus Rd., Mt. Pleasant, MI 48858
Player Name:                                                                                

Address:                                                                                                

City:                                          State:                  Zip:                                

Phone:(        )                                   

Email:                                                        

Date of Birth:                                  

League Division: 35+
(To qualify for multi-league discount, please fill out A, B, or C Registration form and submit along with this form)

Are you on a protected list?                YES                NO

If yes, which team?                                                                        

Position:         Forward                           Goalie

Skill Rating:        1                2                3                4                5
                    Lowest                                                            Highest

Are you a team representative?        YES        NO        
If yes, please submit team representative information form.

Payment Information        Amount Enclosed:                        










Save $100 when you join multiple leagues!

USA Hockey Insurance can be purchased at :
www.usahockeyregistration.com for $35
A copy of USA Hockey registration must accompany this form.

*** Due to MAHA Policy, the ICE Arena can no longer process USA Hockey
Registration on your behalf***

Refund Policy: Prior to 1st game: 1/2 of collected fees
         After 1st game: Permitted only for extreme circumstances


Please make all checks payable to "Smooth Surfaces"

Credit Card Information:
         Circle One:        Visa        MasterCard        Discover

Card No:                                                          Exp.                                

Signature:                                                  

REGISTRATION DEADLINE: September 21, 2008
FEES:
Full Payment
Split
Payment
 PAYMENT OPTIONS
Additional Fees may apply
Amount Due at
Registration
Balance Due by
Dec. 1st, 2008
Player
$300.00
$320.00
$160.00
$160.00
Goalie
$180.00
 $200.00
$100.00
$100.00
Want to Put Your Own Team Together??
Click HERE for Team Rep. Form