GOALIE INFORMATION

First Name *

Last Name *

Contact Email 1 *

Gender

ADDRESS INFORMATION

Street Address *

City *

State/Province/Region *

Zip/Postal Code *

Home Phone Number

Mobile Phone Number *

Westhills Arena - Victoria BC - July 17-20/2023 (6:30 to 8:00 PM)

Oceanside Arena - Parksville BC - Monday Aug 7 to Thursday Aug 10/23 (6:30 to 8:00 PM)

Select Camp Dates: *

Westhills (Victoria) July 17-20/23 $299.00 + GST

Oceanside (Parksville) August 7-10/23 $299.00 + GST

I will be bringing a shooter with me? *

Yes

Payment Options *

Full Payment

Camp Refund Option. What is this? *

Yes

Payment Method *

Visa

Master Card

E-Transfer (email vi@goldinthenet.com)

Name on Card

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Expiration Date (mm/yy)

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