Please call to pay by:

Powerstride is among the very
first to be using state of the art
DARTFISH software technology.

HOLIDAY CLINIC

Dates: December 28, 29, 30, 2010 - Power Skating Clinics

9:00am to 10:00am - Novice/Minor Atom
10:10am to 11:50am - Major Atom/PeeWee/Bantam

Gravenhurst is located about one and a half hours north of Toronto in the heart of Muskoka "Cottage Country". Classes are conducted at the Gravenhurst Centennial Centre. A map is provided for your convenience.

Note: Cancellations prior to full payment due date will be changed a $25.00 administration fee. After full payment due date, NO REFUNDS WILL BE GIVEN.

Personal Information
Name:
Address:
City:
Province:
Postal Code:
Birth Date:
Home Phone:
Cottage Phone:
Email Address:
Cottage Effective Date:
Health Card Number:
Business Phone: (Mother)
Business Phone: (Father)
Mother's Name:
Father's Name:
Session Selection
Power Skating Clinics	- December 28, 29, 30, 2010
	Novice/Minor Atom (9:00am to 10:00am) $45
	Atom/PeeWee/Bantam (10:10am to 11:50am) $75 (under 14) $84.75 (over 14) HST included

Sub Total:
Less Deposit:
(See note below) Balance Due

Payment Balance DUE DATE: NOVEMBER 30, 2010

There will be a $45.00 charge for any NSF Cheques.
Mail Completed form and payment to the address below.
Make cheques payable to:

Powerstride Hockey Techniques Ltd.
853 Adirondack Road
London, Ontario
N6K 4W7

Electronic Bank Transfers are also acceptable at carole@powerstride.com