THE GOALIE CENTRE (TERM 1) 2010 DRYLAND PROGRAM
PHONE: (780) 922-0031    FAX: (780) 922-0024


NAME: ____________________________________________________________


ADDRESS: _________________________________________________________


CITY ____________________________  POSTAL CODE: __________________     


BIRTHDAY: ________________________________________________________


HOME PHONE: _____________________ CELL PHONE: ____________________


EMAIL ADDRESS: ___________________________________________________


GOAL FOR THE 2010 / 2011 SEASON:

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PARENTS: _________________________________________________________


PAYMENT INFORMATION


MASTERCARD: ________________________________ EXP: ________________


VISA: ______________________________________ EXP: ________________


CASH: ____________________________________________________________


CHEQUE: _____________________________________ CHQ#: ______________


TERM 1: 5 Day Program, 10 Weeks
(Mon. Stairs, Tues Gym, Wed Saq, Thurs Gym, Sat P/S)

April 19/10 Thru to June 26/10 - WITH POWERSKATING

COST: $1940.00 PLUS TAX

GYM is ATHLETICA (7508 Gateway Blvd, (780) 641-0888)

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TERM 1: 4 Day Program, 10 Weeks
(Mon. Stairs, Tues Gym, Wed Saq, Thurs Gym)

April 19/10 Thru to June 26/10 - NO POWERSKATING

COST: $1440.00 PLUS TAX

GYM is ATHLETICA (7508 Gateway Blvd, (780) 641-0888)

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TERM 1: 3 Day Program, 10 Weeks
(Mon. Stairs, Wed Saq, Sat P/S)

April 19/10 Thru to June 26/10 - WITH POWERSKATING

COST: $1140.00 PLUS TAX

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TERM 1: 2 Day Program, 10 Weeks
(Mon. Stairs, Wed Saq)

April 19/10 Thru to June 26/10 - NO POWERSKATING

COST: $640.00 PLUS TAX