Back to 3 on 3 Tournament		 Team Application

Please type your team information in the spaces provided, print this page, and send to:
Shoot Out Hockey, Inc. , P.O. Box 1213, Union Lake, MI 48387-1213
Form elements on this page are for typing convenience only!  
With this application, please include:
  • A copy of each player's USA hockey membership card, IMR, CHA or your official team roster stamped by the appropriate IIHF affiliate.
  • Payment in the amount of $200.00 U.S. for 4 skaters and a goalie or $250.00 U.S. if you add a 5th skater for insurance.
  • Make checks payable and mail to: Shoot Out Hockey, Inc., PO Box 1213, Union Lake, MI 48387-1213.
    As a condition of acceptance, "Out-of Town" teams must stay at an authorized Shoot Out Hockey hotel.

Tournament Dates and locations:

 June 3-5 Last Dance Hockey Festival  July 29 - 31 Ann Arbor                                                   

Classification - please check one:
Mite/Novice Squirt/Atom Peewee Bantam Midget

 Level - please check all that apply: 
House Travel Minor Travel Major  AAA

  HSJV H.S. 12&U  14&U  16&U 19&U

 Girls Women Senior Men     

Age Grouping - please check one:  
1997 1996 1995  1994  1993 1992 1991  1990  1989 1988 1987 1986. Sr. open  Sr. o30 Sr. o40  

In the event that teams have mixed age groups or classifications, you need to register at the oldest age group and highest level represented on your team.  This does not apply to the senior divisions. 

 
Team Name:   Contact Name: 
  Address: 
  City/State/Zip:
Phones:    Home: Work:
E-mail: Fax:
Cell: Pager:

Note: Teams should bring both their home and away jerseys to avoid color conflicts
NAME ADDRESS CITY STATE ZIP   BIRTHDATE 
MM/DD/YY
1. Goalie:
2.
3.
4. 
5. 
6.  Extra: 
Visa  Mastercard  CC#:  
Name as it appears on Card: (please print) 

Signature: _________________________________________  Exp.Date: 
pucks@shootouthockey.com | P: 888-355-1113 | Local 248.399.1694 | F: 248.399.0330