Saturday June 7th & Sunday June 8th
Player Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Gender
*
Please Select
Male
Female
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Team Name (If applicable)
Are you a Free Agent?
*
Please Select
Yes
No
Are you the Captain of your team?
*
Please Select
Yes
No
Would you be interested in scorekeeping or reffing?
*
Please Select
Referee
Scorekeeper
Both
No
Please enter your full roster below (If Applicable - Captains Section Only)
First Name
Last Name
Jersey #
#1 (C)
#2
#3
#4
#5 (Optional)
Goalie
Division(s)
*
Please Select
8 & Under
10 & Under
12 & Under
14 & Under
Men's Bronze/Silver
Men's Gold/Platinum
If you are playing in multiple divisions, please fill out separate forms for each division
Registration Fee:
*
Team Fee (3 players and 1 goalie) - $550
Team Fee (4 Players and 1 goalie) - $550
Team Fee (5 Players and 1 Goalie) - $625
Free Agent - Skater - $115
Free Agent - Goalie - $85
Custom Ironman Jersey - Not Required - (Sizing based on jersey size selected below).
Black - $65
White - $65
Both - $125
Player Jersey # (Ironman jersey will be ordered based on this # unless otherwise specified below).
Player Jersey Size (Ironman Jersey will be ordered based on this size unless otherwise specified below).
Please Select
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult Goalie Cut
Questions/Comments (If requesting additional Ironman Jerseys, please enter, sizing, numbers, and colors below.)
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