ADULT ROLLER HOCKEY LEAGUE Hockey Open to ALL BEGINNER MEN & WOMEN Be a part of the FASTEST growing sport in Des Moines!!! Learn to play hockey! *DRAFT Wednesday, Jan 14th & 21st --- 8:15-9:30pm, *Players can Request up to 2 players to be on the same team *Not all request will be guaranteed EQUIPMENT NEEDED: Helmet w/ full face shield, Skates, Stick, Gloves, Elbow and Shin Guards GAMES PLAYED ON Wednesday Nights… 8:30pm & 9:30pm First game will be January 21st at Skate West Recommended: Protective cup & mouth guard Schedules will be posted at www.dmrollerhockey.com Dates & Times subject to change $165 INCLUDES: *Draft *8 Games *2 Jerseys (Home & Away) *Tournament *5 Min Warm up *Games will be Three 18 min periods PERSONALIZED JERSEYS! Fees must accompany registration. Make checks payable to Skate West. Mail to: Skate Centers #10 Sugar Creek Lane Waukee, IA 50263 $10 charge Adult league players will get 15% off all Equipment to get started!! *Skates *Sticks *Pads IF YOU WANT YOUR NAME ON THE BACK JERSEY’S NOTE ON FORM BELOW. WRITE THE NAME YOU WANT. *Bags EX: first, last, Nickname… Adult Winter 15- - - - - - - - - - - - -LEAGUE REGISTRATION FORM - - - - - -- - - - -----Name Male Address Birth date City Experience or State New Player Phone Zip Played in Female Name on back of Jerseys $10 extra, print 1 letter per box Email leagues Player request 1 _____________________2nd_____________________ ___ JERSEY SIZE: Circle One Adult L XL League Fees: $165.00 Jersey Fee Name on Jersey +0.00 +10.00 XXL Amount Due: $ Liability Waiver; I agree to assume full responsibility for any risk implicit or direct by participation in this hockey league at Skate West. Individual, team or group accident insurance is not provided by Skate West for participation in Skate West activities. The individual mentioned had my permission to participate in this activity. OFFICE USE ONLY PAID: Date: Amt: Signature (parent or guardian) Check # Date /cash/MC/Vis a