Register for the BPHL Winter 2011
The registration fee is $475.00 This includes ice time, jerseys, and year end party. Games will be on Tuesday and Thursday nights at Tim Moylan IcePlex. The first game will be on Thursday night, October 20th. | Please mail this registration form and the fee to here: |
Brian Maher
3411 S. 81st Ave.
Omaha, ne. 68124
402-301-3452
Make all checks payable to BPHL. Now accepting VISA and MasterCard. |
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Name (Please Print)
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Address (Please Print)
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City,
State, Zip
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Phone #:___________________________________________
Work Phone #:___________________________________________
Cell Phone #:___________________________________________
E-mail: (Please Print)__________________________________________________
Age:_____
Comments?
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Now Accepting VISA and MasterCard 
Name on Card (if different than above)
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Billing Address (if different than above)
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City
State
Zip
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Card
Number
Expiration Date
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Platinum cancer