REGISTRATION FORM
8th Annual CPA/Ottawa Senators Alumni Wheelchair Relay
June 7th, 2003 Terry Fox Park

 
Select One of the Following Events:  

Morning (Adult Relay)

Afternoon (Youth Relay)  
       
Team Information:    

Name of Organization/School:

   
Mailing Address:
   
City:
   

Province:

 
Postal Code:
 

Phone:

   

Work:

   

Cell:

   

FAX:

   
Email:
   

Team Captain:

    
Name:
   
Mailing Address:
   
City:
   

Province:

 
Postal Code:
 

Phone:

   

Work:

   

Cell:

   

FAX:

   
Email:
   
       
Team Members:
  
Name
Daytime Phone #
Evening Phone #
Has Own Wheelchair?
1:
 
YES
2:
 
YES
3:
 
YES
4:
 
YES
5:
 
YES
6:
 
YES
7:
 
YES
8:
 
YES
9:
 
YES
       

Team Supervisor:

   (If Captain is under 18 years of age)  
Name:
   
Mailing Address:
   
City:
   

Province:

 
Postal Code:
 

Phone:

   

Work:

   

Cell:

   

FAX:

   
Email:
   
       

Band Information

      

Band Name:

   
Band Leader (full name):
   
Mailing Address:
   
City:
   

Province:

 
Postal Code:
 

Phone:

   

Work:

   

Cell:

   

FAX:

   
Email:
   
       

Band Supervisor:

   (if band leader is under 18 years of age)  
Band Supervisor (full name):
   
Mailing Address:
   
City:
   

Province:

 
Postal Code:
 

Phone:

   

Work:

   

Cell:

   

FAX:

   
Email:
   
       
       
TEAM T-Shirts:
   Team shirts may be individualized with your TEAM NAME across the front and purchased at $15.00 per shirt. Minimum order of 5 shirts per team required.  
       
Quantity
   We would like to purchase shirts  
Size
  
Small Medium Large XLarge XXLarge XXXLarge
 
Name to go on shirt
    
Colour