ROLLER RINK NATIONAL CHAMPIONSHIPS

REGISTRATION FORM

Team Name___________________ Contact Person__________________

Phone_______________________ Email__________________________

	Players	#	Position	Birth Date
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.			Goalie
14.			Goalie

Coaches Name_____________________________ Asst. Coach________________________________

Rink_____________________________________ Club______________________________________

Division       –       Youth World____ Tier I_____     Tier II_____

Send your registration to:

June 11 Deadline

SIHA

3325 Meadow Ridge Dr.

Colorado Springs, Colorado 80920

Phone: 719.597.1235    Fax: 719.380.8775