Green Light Adventures Online Registration Form

Spring 2010 Registration Form

Last Name:	*
First Name:	*
Email Address:	*
Phone Number:	*
Fax Number:
Address:
City:
Country:
Postal Code:
Birth Date:
Age:
League:
Check the box if you play goalie:
Describe your in-line/street/ice hockey experience:
List any other players you would like to play with:
Have you previously played rollerhockey with GLA: