Columbus Capitals 2009-2010 Registration
Player Information
First Name
Last Name
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Phone Number
Email Address
USAH Confirmation (if you have not yet sent yours to Mindy)
Date of Birth
Years Played
Prefered Position
Forward
Defense
Goalie
Forward or Defense
Forward or Goalie
Defense or Goalie
St. Louis Trip
St. Louis, MO - November 7-8, 2009
I plan to travel to St. Louis to play the Surge this year.
I DO NOT plan to play the Surge this year.
USAH Nationals
March 27-29, 2010
GREEN BAY, WISCONSIN
30 and Older Division
or C Division
I am 30 years old, or older, and would like to go to Nationals in C or 30+
I do not want to go to Nationals.
I am under 30 and can only go in C, but want to go.
I'm over 30 and only want to play in over 30
I'm over 30 and only want to play in C
2010 POWHA Playoffs
Columbus, Ohio - April 10-11, 2010
I plan to play in POWHA playoffs this year.
I DO NOT plan to plan in POWHA playoffs this year.
2009-2010 Playing Package
Full-Time Player (minimum of 31 Events are available, other games being added): $700 ($650 if paid in full before first event)
Half-Time Player (minimum of 9 games available; all practices included): $450 ($425 if paid in full before first event)
Interested in Tournaments only this year (tournaments paid seperately).
Jersey Size
S
M
L
XL
XXL
Goalie Cut
Jersey Number
I need to borrow a jersey, I understand sizes and numbers are limited.
00
1
4
14
16
19
20
26
28
30
31
34
35
36
37
38
39
40
43
44
45
46
47
48
49
50
51
52
53
54
56
57
58
59
60
61
62
63
64
65
66
67
69
70
71
72
73
74
75
76
78
79
80
81
82
83
84
85
86
87
89
90
91
92
93
94
95
96
97
98
99
Sock Size
Adult - I need socks
Adult - I have socks
Junior - I need socks
Junior - I have socks
Columbus Capitals Merchandise:
I would like to purchase these types of items this season:
T-shirts
Long Sleeve T-Shirts
Hats
Hooded Sweatshirts
POWHA Championship T-shirt
POWHA Championship Long Sleeve T
POWHA Championship Sweatshirt
Sweatshirts
Fleeces
Warm-ups
Winter Parka
None
T-shirt Size
Small
Medium
Large
Extra Large
XXL
XXXL
Pant Size
Small
Medium
Large
Extra Large
XXL
XXXL
Additional Information
Cell Phone Number
Alternate Email Address
Emergency Contact Name
Emergency Contact's Phone
I know someone who can/would like to help as a:
Manager
Coach
Scorekeeper
Sponsor
None at this time
Prospective Helper's Phone Number
Prospective Helper's Email
Prospective Helper's Email
TOURNAMENTS:
Tournaments are not included in package price.
Possible/Likely 2009-2010 Tournaments
I want to play with the Caps in the following tournaments:
Autumn Classic (Strongsville, OH), November 13-15, 2009
Windsor, Ontario (Feb 12-14, 2010)
Spring Fling (Bolingbrook, IL) (Dates not announced yet, usually in mid-April)
Cincinnati Rising Stars Tournament (End of April, 2010)
None of the above
Payment Information
Method of Payment:
I am sending a check to: COGWHA, 5979 Heritage Farms Dr, Hilliard 43026.
I would like to use PayPal. I understand there is a 3% charge to do so and that Marianne will send me a bill via email.
I am paying by check and would like to pay $100 per month. I will send my checks to: COGWHA, 5979 Heritage Farms Dr, Hilliard 43026.
Indicates Response Required
Powered by
FormSite.com