Stomp Registration

4362 Jordan Road, Jordan Station ON L0R 1S0

Phone: 905 562-6279 Fax: 905 562-3829

2011 Registration Form

Team pre-registration is necessary to reserve your spot in the stomp. Team Registration is $20 payable during registration from 12-1 pm on Sept 24.

General Information(*required field)

*Team Name

Team Member One Info

*First Name *Surname

*Address

*City *Province/State *Postal/Zip Code

*Phone Number *Email Address

Team Member Two Info

*First Name *Surname

Address

City Province/State Postal/Zip Code

Phone Number Email Address