EmailMe Form - June 27-29 CanPowerSkate Course Registration

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone *

### - ### - ####

Birthdate (ddmmyyyy) *

Age (as of March 7, 2014) *

Skate Canada Number *

CC Number

Please note that the above CC number is not required. If you do not have your CC number instructions will be provided through email after registration.

Note:

Participants must meet and submit the following when registering. Registrations will not be accepted without the required documentation.

Your Skate Canada Membership card and your highest test passed can be found at:

www.skatecanada.ca - Members Only - Personal Profile - General Information

Course Pre-Requisites (Check coaching status that applies to you) *

Must be a registered Skate Canada Member for the 2013/2014 Season

Hockey Community Coach Stream

Ringette NCCP Community Sport Initial Workshop

CanSkate Coach Status or higher

Must be 16 years of age

Upload your 2013-2014 Skate Canada Membership Card *

Upload proof of coaching status *

Upload proof of age *

I have uploaded the above per-requisites to attend the CanPowerSkate Course and understand that this is a requirements in order to attend the course. *

Yes

Liability and Cancellation Policy

By checking the below box, it is understood and agreed that Skate Canada: Alberta-NWT/Nunavut will not be liable for injury or loss occasioned by the participant while traveling to or from or during the Course nor shall Skate Canada: Alberta-NWT/Nunavut be responsible for any damages or losses caused by the participant during the same time. The participant and/or the participant's parent/guardian agree to indemnify Skate Canada: Alberta-NWT/Nunavut and hold it harmless from any claims or demands in respect of such loss or damage.

By checking the below box, it is understood and agreed that cancellations occurring after the application deadline date will not receive a refund, unless a medical certificate is provided within two weeks of the course date. Cancellations prior to the application deadline date will receive a full refund less a $10.00 administration fee. Skate Canada: Alberta-NWT/Nunavut reserves the right to cancel any courses after the deadline date due to lack of registration. If the Section chooses to cancel a course, a full refund will be provided.

I have read and agree to the above Liability and Cancellation Policy

Yes

Payment Information

I understand that the course fee is $320.00 *

Yes

I am paying by *

Mastercard

Visa

Name on Card *

Credit Card Number *

Expiry (mmyyyy) *

Please send receipt to the following email address: *

Course confirmation and further details regarding the course will be sent via email.

After clicking 'Submit' button below your registration for the CanPowerSkate Course is complete. Thank you for registering for the upcoming CanPowerSkate Course.