October 21-23, 2011 The 949 Roller Hockey Center - Irvine, CA

TEAM REGISTRATION INFORMATION

Teams registered by September 23rd pay $450, after the 23rd the fee increases to $500. ALL REGISTRATIONS MUST BE COMPLETE AND PAID IN FULL BY OCTOBER 14TH! Sign up two blood donors and save $25 on your fees. Pay your fee on line at www.tinyurl.com/GBPH-REG-n-PAY All Team Registrants Must Complete and Submit the Following Information:
TEAM REGISTRATION INFORMATION, pages (1 and 2). OFFICIAL ROSTER 949 WAIVER FORM FOR EACH PLAYER

Submit Your Completed Registration Packet To:

949 Roller Hockey Center 3150 Barranca Parkway Irvine, CA 92606 (949) 559-9949 By Fax: (949) 559-9948 By EMAIL: gbph2011@gmail.com

If you, your team, or your Company, would also like to be an event sponsor please contact us at 714-330-1602 or email us at GBPH2011@gmail.com

October 21-23, 2011 The 949 Roller Hockey Center - Irvine, CA

MAKE YOUR TEAM PAYMENT ON LINE AT: www.tinyurl.com/GBPH-REG-n-PAY

TEAM REGISTRATION INFORMATION

1 of 2
Team Name Coach/Manager Name Coach/Manager Address City Home Phone EMAIL (required) State Cell Phone Zip

Page

Please complete the following registration information by checking the blank next to the division and level of play for your team (type in X). Please complete one form for each team you wish to register. Age cut off for the club division is based on the players age as of December 31st, 2010. Please see the roster guidelines with the enclosed tournament rules and regulations.
Teams and Age Groups Divisions based on age as of December 31, 2010 Club Division Parent Child Division Skill Level Team Gender Scholastic Division Jr. High High School College Varsity Varsity Div. 1 JVA JVA Div.2 JVB JVC 8U Male Beginner Male 10U Female Intermediate Female 12U
Co-Ed

14U

16U

18U

Adult

Advanced Co-Ed

What Division did this Team play in the 2010 Season? What is this Teams Home Rink? (enter name of rink) Any Comments about this Team?

October 21-23, 2011 The 949 Roller Hockey Center - Irvine, CA

Giving the Gift of Life

TEAM REGISTRATION INFORMATION
2 of 2
Team Name Age Level / Division

Page

PLAY. GIVE. DONATE. SAVE AN ADDITIONAL $25 BY SIGNING UP TWO BLOOD DONORS!
The tournament entry fee is tax deductible, and if you register at least two adults to give blood you can apply a $25 discount to your registration fees. Pay early and save $50! FINAL REGISTRATION DEADLINE IS OCTOBER 14th. ONLINE REGISTRATION AND PAYMENT SITE: www.tinyurl.com/GBPH-REG-n-PAY Select your tournament entry fee:
$450 PER TEAM $500 PER TEAM $25 PER TEAM ( $ DONORS: Blood Donor #1 Blood Donor #2 Name Name Age Age Phone Phone ) Early registration by September 23, 2011 Registration after September 23, 2011 Discount for Two Blood Donations Your Team Fee $

All fees are to be paid by credit card, cash, check, or money order and are due by OCTOBER 14th. Please make checks payable to: CHOC Foundation for Children Tax ID# 95-6097416
Please Charge My: Card # Name on Card Billing Address City Signature State Zip
(Enter one: Visa, MasterCard MC, American Express AE)

Exp.

Completed registration packets may be delivered to the 949 Roller Hockey Center or Faxed to (949) 559-9948, or e-mailed to GBPH2011@gmail.com. For more information, please refer to our web site: www.GIVEBLOODPLAYHOCKEY.org or consult with your GBPH volunteer.

October 21-23, 2011

The 949 Roller Hockey Center - Irvine, CA

OFFICIAL ROSTER
Team Name Division Player Name Jersey # Email address

Goalies:

Coach or Captain Name Assist. Coach or Captain Name

I hereby certify that each of the players listed above are of the proper age and skill level for the division we are registering our team.
Coach or Captain Signature Date