May 6 & 7, 2016

The Sports Village, 2600 Rutherford Rd, Vaughan

Team __________________________________

Team Rep __________________________________

E-mail/ Phone __________________________________

# of Teams ______ Division A, B, C, Over 35.

$1100.00 per team X ____ # of teams = $_________

Check payable to ‘Dan Fleming’

$400.00 Donation to Threads of Life Foundation

Check payable to ‘Threads of Life Foundation’

Limited to 25 teams

Registration deadline – April 1, 2016

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Mail to: Dan Fleming

3274 Camborne Crescent

Mississauga, Ont. L5N-5G4

Do you wish to purchase individual player insurance at $23 per player: ___no   ___ yes (insurance contact information will be provided)