Powerstride Hockey Techniques Ltd. - Gravenhurst Registration

Please call to pay by:

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

Note: Cancellations prior to full payment due date will be charged 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/Conditioning & Shooting Clinics	August 1st to August 5th, 2011
	Novice/Atom Power Skating $160
	Novice/Atom Shooting Clinic $135
	PeeWee/Minor Bantam Power Skating $160
	Shooting Clinic - Pee Wee and Up $135
	Major Bantam/Midget/Junior PowerSkating/Conditioning $180
Pre-Season Training Camps	- August 8th to August 12th, 2011
	Pre-Novice & Novice - $400
	Atom & Pee Wee - $400
	Bantam/Midget/Junior $400 (under 14) $452 (over 14) (HST included)
Program Sub-Total:
Less 10% Discount when Applicable
Sub Total:
Less Deposit:
(See note below) Balance Due

Payment Balance DUE DATE: JUNE 1, 2011

There will be a $30.00 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