PINE RIVERS INLINE HOCKEY CLUB 2016 UNIFORM ORDER FORM TO BE RETURNED TO CLUB BY MONDAY 8/2/16 PLAYER: NAME: __________________________________________________________ DIVISION: ________________________________________________________ POSITION: _______________________________________________________ JERSEY NUMBER PREFERENCE: 1ST ________ 2ND ________ 3RD _____________ NAME ON JERSEY: _________________________________________________ ITEM SIZE QTY PRICE TOTAL (AD/CH) JERSEY 0 $95.00 $ 0.00 Sizes:- Child S, M, L, Adult S, M, L, XL, XXL, XXXL COVERPANTS 0 $95.00 $ 0.00 Sizes:- TOTAL $ 0.00 UNIFORMS RECEIVED: __________________ PARENT’S SIGNATURE: ____________________________________ PRILHC TO COMPLETE FORM RECEIVED: _____________________ ORDER PLACED: ______________________ORDER RECEIVED: ____________________
PINE RIVERS INLINE HOCKEY CLUB 2016 UNIFORM ORDER FORM TO BE RETURNED TO CLUB BY MONDAY 8/2/16 PLAYER: NAME: __________________________________________________________ DIVISION: ________________________________________________________ POSITION: _______________________________________________________ JERSEY NUMBER PREFERENCE: 1ST ________ 2ND ________ 3RD _____________ NAME ON JERSEY: _________________________________________________ ITEM SIZE (AD/CH) QTY PRICE TOTAL JERSEY Sizes:- Child S, M, L, Adult S, M, L, XL, XXL, XXXL 0 $95.00 $ 0.00 COVERPANTS Sizes:- 0 $95.00 $ 0.00 TOTAL $ 0.00 UNIFORMS RECEIVED: __________________ PARENT’S SIGNATURE: ____________________________________ PRILHC TO COMPLETE FORM RECEIVED: _____________________ ORDER PLACED: ______________________ORDER RECEIVED: ____________________
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