Name:                                                                     

Male/Female:                                                            

Skill Level:    1    1.5    2    2.5     3     3.5     4     4.5     5   (1=Beginner)

Can you be a goalie for part of a Game?        Y / N   

Division: Tuesday Recreational   Wednesday Recreational   Thursday Recreational 

Street Address:                                                       

City:                               Postal Code:                      

Phone:                                                                     

Email:                                                                     

Fee Enclosed: $                                                        

Spring /  Summer  /  Fall League

Make Cheques Payable to Perpetual Motion

- Individuals can register for $40*/person per league

 (However, team placement is not guaranteed and subject to available space)

* = includes G.S.T.

 

 Please place me on the same team as my friend(s) listed below:

Name	Phone Number	Email	M/F
1)
2)
3)
4)
5)