Print form and mail with registration fee to:

 Skateland West    37550 Cherry Hill       Westland, MI 48185

INLINE Hockey Registration Form

  CIRCLE ONE:      Fall 2008    Winter 2009     Spring 2009

League Divisions by Age:    Circle One please

8 and Under,    10 and Under,     12 and Under,     14 and Under,   16 and Under

Youth League: $120.00 Early Registration*

(EARLY REGISTRATION ENDS:  September 19th)

Youth League:     $140.00 Late Registration* 

Name______________________________________Year of Birth________

Address_______________________________________________

Phone Number___________________________________________

Interest in Playing Goalie:              Always         Sometimes         Never

Jersey Size:            Mite         Child        Youth         Junior        Adult        Goalie

Interested in Coaching:        Yes/No

Parents name if Coaching:__________________________________

Phone Number if different than childs:____________________________

Paid Registration on ___________________ Cash    Check     Charge

Received By:_____________________________ 

*an additional $30.00 annual fee is paid to USA Inline for membership which is mandatory