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 Victoria - Monday July 18 to Thursday July 21/22 (6:30 to 8:00 PM)

Oceanside Arena - Parksville BC - Monday Aug 1 to Thursday Aug 4/22 (6:30 to 8:00 PM)

Select Camp Dates: *

Westhills (Victoria) July 18-21/22 $299.00 + GST

Oceanside (Parksville) August 1-4/22 $299.00 + GST

I will be bringing a shooter with me? *

Yes

Payment Options *

Full Payment

Name on Card

CVV Number

Credit Card Number

Expiration Date (mm/yy)

Credit Card Billing State/Postal Code

I/we acknowledge that I/we have read the GITN Waiver, Terms & Conditions link below.