FARMINGTON HILLS ADULT HOCKEY ASSOCIATION

2012 – 2013 FALL / WINTER REGISTRATION

INDIVIDUAL ENTRY - OVER 40 DIVISION

THE SEASON WILL START THE SECOND WEEK OF SEPTEMBER 2012 WITH TWO (2) GAMES PER WEEK. Games will be on Sunday nights, also Wednesday/Thursday (possibly occasional Friday) nights at the Farmington Hills Arena and Suburban Arena in Farmington Hills.

Teams (16 planned) will have 10 skaters plus a goalie. Each team will play 45+ games including playoffs, but it may be necessary to slightly modify the number of players per team, scheduled games and fees based on registrations received. All players must reach age 40 by December 31, 2012. Proof of age is required for players that did not skate in the program in the 2011 / 2012 season.

All players that have not skated in our league must attend a mandatory rate skate in full equipment. This will take place at Suburban Ice Arena on Sunday night, August 19, 2012 from 8:00 to 8:50 pm. Notification will be issued to new players. Failure to participate in a rate skate will result in that player being placed on the sub list.

INDIVIDUAL REGISTRATION - OVER 40

Name ______Age ______Birth Date ______

Address ______

City ______State ______Zip ______

Phone including area code:

Home ______Work ______Cell______

E-mail ______

Skill Rating (circle one) (highest) 1 1.5 2 2.5 3 3.5 4 4.5 5 (lowest) Shoots Right Left

Preferred Position (circle one) Forward Defense Forward / Defense Goal

Did you play in the Farmington Hills Adult Hockey League in 2011/2012? Yes Team: ______No

Are you willing to be a team coach? Yes No Interest in Board Position? Yes No

Note: In the case of significant injury the Board has the discretion to grant a full or partial refund or credit.

SIGN AND ENCLOSE THE ATTACHED WAIVER/CODE OF CONDUCT FORM WHEN SUBMITTING THE REGISTRATION FORM ALONG WITH ENTRY FEE.

The total cost for the season is $760. Goalies play free. All applicants must complete a registration form AND sign the waiver/code of conduct form, and skaters must submit a $200 non-refundable registration fee. The second payment for ice fees will be $280 due at the first scheduled game. The remaining balance of $280 is due no later than November 1, 2012.

A $25 discount is available for individuals who submit the full payment with their registration. To take advantage of this discount, please submit a check or money order for $735 with your registration.

Registrations will be accepted through July 31, 2012 or when division is full. Registrations received after July 31, 2012 will only be processed if there is an opening. Direct all questions to FHAHA at 248-471-6004 or to the fhaha.com website.

MAKE CHECKS OR MONEY ORDERS PAYABLE TO: FARMINGTON HILLS ADULT HOCKEY (NO CASH)

Mail to: FARMINGTON HILLS ADULT HOCKEY ASSOCIATION

P. O. BOX 3357, FARMINGTON HILLS, MICHIGAN 48333

ENTRY FEE MUST BE SUBMITTED WITH REGISTRATION FORM.