Print this form, fill the informations and send it. (please typewrite) 

February 6th to 19th 2012
 INSCRIPTION FORM ( Class A, B, BB, CC)

___________________________________________
 Name of Team 

________________________
Classification

___________________________________________
 Name of Manager

________________________
Home telephone

___________________________________________

___________________________________________
 Address of Manager (street, town, province) 

________________________
 Postal Code

___________________________________________
Fax number

________________________
Email

___________________________________________
 League Name

 

___________________________________________
 Manager's signature

________________________
 Date

 

To which other tournaments are you registered ?       

  1. ___________________________________________________

  2. ___________________________________________________

  3. ___________________________________________________

Amount included : $ ____________

450$ / quebec team

500$ cdn / outside quebec

****** RESTRICTIONS ******

Do you have dates restrictions (scheduled games in your league, other tournament, etc...) : yes ___no ___  If yes :_________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________

If in one class, the number of inscriptions exceeds the number of teams accepted, the priority will go to teams with less restrictions.

PLEASE return this inscription form WITH your cheque BEFORE OCTOBER 10th, 2011

envloppe.gif (36014 octets) Mousquiri National
Atom Tournament
P.O. Box 3125
Richmond, QC,CA
J0B 2H0		 telecopieur.gif (2969 octets) Phone number:
 819- 570-3719
Fax:
 819-826-1970		 email.gif (8876 octets)

www.mousquiri.com
tournoiatome@mousquiri.com
guillaume.mousquiri@yahoo.ca