After completing the form below, click SEND.
The confirmation page will contain a receipt for your records
if you wish to have a copy for your records.

Team Name:
Team Sponsor Name:		Same as above, or If different, please enter below:
Mailing Address:
City:
Postal Code:
Please select from the options below applicable to this application:
Team Fee:		$975
Sponsorship:		Platinum $3,000
		Gold $2,000
		Silver $1,000
		Bronze $500
		Business Card Ad in Program $300
TOTAL Fee(s): $		*Shared team fees must be submitted together.
Primary Contact:
First/Last Name:
Business Phone:
E-Mail
Secondary Contact:
First/Last Name:
Business Phone:
E-Mail
Division Last Year (2011):		AVIVA (Slapshots) GUARANTEE (Slapshots) DOMINION (Slapshots) SERVICEMASTER (NO Slapshots) INTACT (NO Slapshots) ECONOMICAL (NO Slapshots)
Division Request for THIS year (2012):
Submitter Contact:
Your Name (First/Last)
Street Address
City
Phone Number
E-Mail
Comments / Questions:
Please enter the text from the image
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2012 Ontario General Insurance Hockey Tournament,
72 Regina Street North,
Waterloo, Ontario N2J 3A5

Payment must be received before team registration and/or sponsorship can be processed.