ENTRY FORM
Return by October 26, 2015 to:
BOB MERKLEY MEMORIAL REGIONAL SILVER STICK TOURNAMENT
c/o Ross McConnell, Tournament Registrar
616 Randles Crescent
Midland, Ontario L4R 4V4
Telephone (705) 526-3634
Bantam/Midget – Nov 27th Nov 28th Nov 29th , 2015
Novice/Atom/PeeWee – Dec 4th Dec 5th Dec 6th , 2015
Name of Team:
Division: Novice: Bantam:
Atom: Midget:
Peewee:
Classification: “A” “BB”
City or Town: Population:
Name of League:
Name of Convener: Telephone# of Convener:
COACH MANAGER
Name: Name:
Address: ___________________________________ Address: ___________________________________
Town: Postal Code: Town: Postal Code:
Telephone: (H) (Cell) Telephone: (H) (Cell)
Fax: Fax:
E’mail address: _____________________________ E’mail address: ______________________________
Primary Contact: ____________________________ Cell # of Primary Contact _________________
Sweater Colours
Home Body: Visitor: Body
Trim: Trim: