12th Annual

April 23th - 25th, 2010

	Full Name (please print)	Birthdate (M/D/Y)	E-mail Address
Skip	_____________________________	_____________________________	_____________________________
Third	_____________________________	_____________________________	_____________________________
Second	_____________________________	_____________________________	_____________________________
Lead	_____________________________	_____________________________	_____________________________
Coach	_____________________________	Home Club ______________________________________________________
Contact	_________________________________________________________________________________________________ name & mailing address
phone - day	_____________________________	phone - evening __________________________________________________
Competitive	circle one	Recreational	Entree Fee:   $280.00
Entree fee must be paid in full before confirmation - no post dated cheques

Send Registration Form and Fees to: Kevin Martin's Junior Bonspiel 6501 - 115 Street, Edmonton, AB T6H 2V8