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

SPRINGBREAK CLINIC

Dates: March 15, 16, 17, 18, 19, 2010 - Hockey Development Clinics

9:00am to 10:20am - Novice/Minor Atom
10:30am to 11:50am - Maj. Atom/PeeWee/Bantam

Woodstock District Community Complex

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
Hockey Development Clinics	- March 15, 16, 17, 18, 19, 2010
	Novice/Minor Atom (9:00am to 10:20am) $105
	Maj. Atom/PeeWee/Bantam (10:30am to 11:50am) $105

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

Payment Balance DUE DATE: FEBRUARY 15, 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