Boulder Jr. Bison

Player Information:

Name:                                                                                  

Email:                                                                             

Mailing Adress:                                                                                 

City:                                              State:         Zip:                           

Phone:                                                        

Position:                                    D.O.B:                                     

Height:                            Weight:                         Shot:                             

Last team:                                                                                                      

Coach name and number:                                                                      

USA Hockey 2010/2011 confirmation: #                                                                               

Payment Method:  Camp Cost is $150.00

Please circle one:     Check     Cash     C.C

C.C Type:                                                                          

C.C #                                                                                                  

Expiration date:                                                     

Signature:                                                               Date:                           

 Please return to:

Boulder jr.A Bison

125 Superior Plaza Way

Superior, CO

80027

fax# 303-494-5180

or

pointnight@aol.com