BC SUMMER GAMES

ZONE 6 ATHLETE REGISTRATION FORM

NAME _____________________________________ M/F BCA # ________________

ADDRESS ________________________________________ CITY _______________

POSTAL CODE ____________________________ PHONE NUMBER __________________

E-MAIL ADDRESS __________________________________________________________

BIRTHDATE _____/_____/_____ BIRTH CERTIFICATE NUMBER* ___________________

DAY MONTH YEAR

* only the number and province is required for Canadian Birth Certificates. If outside of Canada, please supply a photocopy of official document showing date of birth (foreign birth certificate, passport page, etc.)

Please return a completed copy of this form to Tom Dingle:

By Email: tdingle@uvic.ca

By FAX: (250) 655-5206

By mail: see below

ADDITIONAL CHARGES IF SELECTED TO THE GAMES TEAM

1. $50.00 cheque made out to BC Athletics at time of selection __________
2. $15.00 cheque made out to BC Athletics at time of selection __________
3. $10.00 cheque /registration forms for BC Athletics if not a member. __________
4. One cheque or credit card may be used for any or all of the above charges.

TOTAL __________

As soon as you have been informed that you are a member of the Zone 6 team, please send a cheque for the above total (made out to BC Athletics) to:

Tom Dingle

8893 Marshall Road

Sidney, BC V8L 1J4

T-SHIRT INFORMATION

The shirts are short sleeved in each zone colour. You must compete in the zone shirt at all times and may not alter the shirt in any way. The Abbotsford 2004 Games logo will appear on the front. PLEASE CIRCLE THE SHIRT SIZE YOU WISH TO HAVE.

Shirt sizes are: SMALL MEDIUM LARGE EXTRA LARGE DOUBLE XL