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)