**IMPORTANT**
Your registration will not be complete until we receive your payment information!

Payment Information:  

^{Player Name:}    

^{Registration for:   Fall '07-'08     Spring '07}        Playing Level - Birth Year MIGHTY MITE -Born 1999 or After NWHL MITE - Born 1999 or After NWHL SQUIRT - Born 1997 & 1998 NWHL PeeWee- Born 1995 & 1996 NWHL BANTAM- Born 1993 & 1994 NWHL MIDGET- Born 1989 - 1992 Girls U10 - Born 1997 & 1998 Girls U12- Born 1995 & 1996 Girls U14- Born 1993 & 1994 Girls U16- Born 1991 & 1992 Girls U19- Born 1988 - 1990

^{Payment Method:} Visa MasterCard Check Cash        ^{Amount Paid:}    (see below)

^{Card Number: Exp Date:} Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2007 2014 2008 2009 2010 2011 2012 2013 2014

^{Name on Credit Card:}

 
^{Signature Authorization:}  ____________________________________________________

                        ^{(Note: a 3% Service Charge will be added for all Credit Card Transactions)}

YOU MUST PRINT THIS FORM! PAYMENT AMOUNT (all payments are non-refundable)    Fall 2007-08 Fees LEVEL PLAYER FEE RAFFLE DEPOSIT OCT. 1 NOV.1 DEC.1   Mite $1,600.00 $250.00 $350.00 $500.00 $500.00 $250.00   Squirt $1,600.00 $250.00 $350.00 $500.00 $500.00 $250.00   PeeWee $1,650.00 $250.00 $350.00 $500.00 $500.00 $300.00   Bantam $1,700.00 $250.00 $350.00 $500.00 $500.00 $350.00   Midget $1,750.00 $250.00 $350.00 $500.00 $500.00 $400.00   Make your check made payable to: Admirals Hockey Club Complete and print this form and mail to: Admirals Hockey Club 1N450 Highland Ave Glen Ellyn, IL  60137 or fax it to 630-790-9695

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