Havoc Hockey Elite Invitational Tournament
Entry Fee Deposit 2019
$540.75
$500 Deposit + tx + CC fee *Note - Deposits are NON refundable Balance of Entry fee will be Due: Jan. 15th
Billing Information
First Name
Last Name
Email
Address
City
Prov/State
AB
BC
MB
NB
NL
NS
NT
ON
PE
QC
SK
YT
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
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MD
ME
MI
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MO
MS
MT
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NH
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OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Postal Code/Zip
Cell Phone
Home Phone
Work Phone
Notes
Team Name
Birth Year
2004
2005
2006
2007
2008
2009
2010
2011
2012
Managers Name
Managers Cell #
Managers Email
Head Coach Name
Head Coach Cell #
Head Coach Email
Additional Comments
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Quantity
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10
Total Price
$540.75
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