mid-hudson polar bears patriot cup
TRANSCRIPT
M I D H U D S O N C I V I C C E N T E R . O R G
8U MITE • $650 PER TEAM ($550 each additional team from same organization)
4 Games Guaranteed • 30 Minute Games • 3 Divisions Winner of each division will be awarded a banner!
NOVEMBER 13TH & 14TH, 2021Location: IceTime Sports Complex
2021
PATRIOT CUPCUPMID-Hudson Polar Bears
For more information and to register, please contact Geoff at [email protected]
2021 PATRIOT CUPNOVEMBER 13TH & 14TH
2021 REGISTRATION FORM
NAME: __________________________________________________________________________________________________________
ADDRESS: ______________________________________________________________________________________________________
CITY: __________________________________________________________ STATE: _______________ ZIP: ____________________
PHONE #: _____________________________________________________ EMAIL: ________________________________________
TEAM INFO ______________________________________________________ AGE: _________ DOB: ___________________
TEAM NAME: __________________________________________________________________________________________________
CONTACT: _____________________________________________________________________________________________________
ORGANIZATION SPONSOR: ____________________________________________________________________________________
TEAM FEE: $650($550 EACH ADDITIONAL TEAM FROM SAME ORGANIZATION)
8U A 8U AB 8U C
Payment Policy: There will be no refunds, no exceptions. Makeups or credit policy: There will be no makeups or substitutions.
Must receive full payment by October 13, 2021.Payment Info: Please make checks payable to Mid-Hudson Civic Center Inc. Mastercard or Visa only for credit card payments (+admin fee of 4%).
Checks can be mailed to: Mid-Hudson Civic Center Inc. Box Office, 14 Civic Center Plaza, Poughkeepsie, NY 12601
Credit Card Number: __________________________________________________________________ CVV Code: _____________
Cardholder Name: ____________________________________________ Exp Date: _____________________________________
SPACE IS LIMITED!
DIVISIONS: