Prince Geroge Registration

July 12th, 13th and 14th 2010

Two sessions - see below

Use this form to register for Six Pack U please fill it in, and press submit.


Make Cheques payable to :
Six Pack Sports

Mail to :
Six Pack U
1697 Merlot Dr.
Westbank B.C.
V4T 2X4

To pay with a credit card, please submit in this form and Dave will contact you by phone.

 

Mandatory fields are indicated with a *

* Choose payment option: I am sending a cheque
I am paying by credit card
     (please call me)
* Choose Camp:
--- PRINCE GEORGE --- --- PRINCE GEORGE ---
Elite Half Day ($130)
     for Grades 10 to 12
All Day ($180)
     for Grades 4 to 9
* First Name:
* Last Name:
* Gender: Male
Female
* Date of Birth
Year
Month
Day
* Address :
* City :
* Province or State:
 Please use 2 letter abbreviation
* Country:
* Postal code or Zip code:
* Home phone number: area code: phone:
* Your Email address:
* Your school:
* Grade entering:
* Care card number:
* Emergency contact name:
* Emergency contact phone number: area code: phone:
Medical conditions
we should know
about:
* T-Shirt Size Youth Small (8-10)
Youth Medium (10-12)
Youth Large (14-16)

Small
Medium
Large
X-Large
XX-Large

 

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