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2019 Fall East End Training - Sept 16 - Nov 18
Registration for the 10 week EAST END program. All sessions hosted at the Oshawa Civic.
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PLAYER NAME (First, Last)
*
Your answer
PRIMARY FAMILY EMAIL
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Your answer
SECONDARY EMAIL
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Your answer
Date of Birth
MM
/
DD
/
YYYY
HOME ADDRESS (STREET, CITY, POSTAL)
*
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PRIMARY PHONE #
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SECONDARY PHONE #
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Field Position
*
Attack
Midfield
Defense
Goalie
AGE GROUP
*
Youth 6-730pm
Academy 7-830pm
Women's 730-9pm
Other:
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Payment Terms
*
All 10 weekly sessions $300 (Sept 16 - Nov 18)
I am a 2019 - 2020 EDGE Member
Required
Payment Note
Once Payment Terms have been selected and submitted, you will receive an updated invoice with balance and payment schedule from Gord Brown (
gbrown@edgelacrosse.com
)
PAYMENT TYPE
VISA
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CARD NUMBER
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Name as Appears on Credit Card
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EXPIRATION MM-YY
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CSV (3 digit code)
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Comments (please list any allergies, conditions or additional info)
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