FLORIDA EELS 2017 REGISTRATION FORM FOR THE Junior CHOWDER CUP
JULY 20 – 23rd, 2017 (Birth Years 2001)
Name:_____________________________________ Cell Phone:____________________
Parent/Guardian Name:_______________________ Cell Phone:______________________
Address:_________________________________________________________________
City:____________________________________ State:________ Zip Code:___________
Date of Birth:__________ Graduation Year:______ School Attending:__________________
Player Email:__________________________ Parent Email:_________________________
Last Team PlayedFor:_______________________________________________________
Level: HS ______ A_______ AA _____ AAA ______ Juniors_______
Position: Goalie L-Defense R-Defense Right Wing Left Wing Center
Height:______________ Weight:________________ Shot:________ Glove:____________
Statistics: Goals:_______ Assists:________ Penalty Minutes:_________ GAA:___________
The cost of the tournament is $275.00. All players are responsible for their own transportation, lodging, and meals.Please remit your payment to the address listed below. All checks should be made payable to the FLORIDA EELS.
Frank Scarpaci
2250 Broadway
Fort Myers, Florida 339
If you wish to pay the tournament fee by credit card, please provide the following information:
Name as it appears on card:__________________________________________________
Billing Address:____________________________________________________________
City:____________________State:__________________ Zip Code:__________________
Credit Card No.:____________________________________ Exp. Date______________
3 digit code on back of card:____________________