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					                       2011 NoCo Adult Summer Registration
Please Print clearly
Player Information:
Free Agent:______________________         Team Name:_____________________________
First and Last Name:________________________________________________________________
Address:__________________________________________________________________________
City:__________________        State:________________           Zip:_______________
Phone:___________________________________________________________________________
E-Mail:___________________________________________________________________________

Divisions: (circle all that apply)
Mon HC      Tue C        Wed B     Thur LB            Fri D       Sun LC           Sunday beginners class

Cost:
Total cost for the league is $210.00                     $ 210.00 x_____                              ________
Punch card coupon (-20.00)cannot be used with multiple leagues             -                          ________
Captain Jersey discount (-75.00)                                           -                          ________
Beginners class discount (-60.00)                                          -                          ________
Multiple leagues (-25.00 each league)                  minus $25.00 x_____                            ________
Donation to NCYH (+ all tax deductible)                                   +                           ________
Total cost for all leagues you are playing in                             =                           ________

PAYMENT PLANS: You are not registered on a team unless you have a payment plan
Option 1: Pay in Full                                                    =                            ________

Option 2:Total from option 1 + 5.00 divided by 2 (2nd Payment due JULY 1 )                            _________
           (you must leave a credit card or post dated checks)

Option 3:Total from above + 15.00 divided by 4 (1/4 payments due 6/1, 7/1, 8/1 )                      _________
           (you must leave a credit card or post dated checks)
Credit card # ____________________________________________________
         Expiration date:_______________________ Cvv2#_____________
In Signing the bottom of this sheet you agree to all the rules of NoCo, as well as grant NoCo permission to withdraw the
final payment(s) from your credit card on the dates stated above.
                 ALL DECLINED CREDIT CARDS AND BOUNCED CHECKS WILL HAVE A 25.00 fee per occurance

NoCo is not affiliated with any outside insurance agencies that provide specific hockey insurance or benefits. It is highly
recommended that you provide your own insurance. This is a play at your own risk league. NoCo is not responsible for
stolen items, injuries, or death. NoCo is not affiliated with USA hockey, however all refs officiate with USA hockey rules with
a few exceptions (these are given to you at the beginning of each season) all rules are located online at nocoicecenter.com

I have read and understand this agreement and I am aware that by signing this agreement I am waiving certain
legal rights including the right to sue the arena and the league.
Sign:________________________________________________________________________________
Date:________________________________________________________________________________
Parent signature if under 18:___________________________________________________________
* NoCo's policy: There are NO Refunds*

				
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