SATURDAY-SUNDAY, JUNE 14-15, 2014

HUMBER COLLEGE - NORTH CAMPUS

205 HUMBER COLLEGE BLVD, TORONTO, ON M9W 5L7 WWW.OMFRC.CA

COMPETITORS REGISTRATION FORM

Home Branch :_______________________ CS Division:________________________________________ Unit#:____________

COMPETITOR INFORMATION
Name of Team: ____________________________________________________________________________________________
Name of Team Members (Full name):
1. _____________________________________________

2. ______________________________________________________

3. _____________________________________________

4. ______________________________________________________

Optional Spare:

__________________________________ Coach: ________________________________________________

Please note: All prices are per individual

Competitors/Coach

Housing
Fri. June 14
$45

Housing
Sat. June 15
$45

Banquet
Sat. June 15
$35

Total

01

02

03

04

05

06
Team Balance

Send the completed form together with payment by : May 2, 2014

St John Ambulance - Council for Ontario
15 Toronto Street, Suite 800
Toronto, ON M5C 2E3

Attn: Monique Rhooms-Napier

Fax: (416) 923-4856
Email: monique.rhooms@on.sja.ca

Payment can be made by cheque or money order payable to the St. John Council for Ontario or by credit card:

MC

Visa

American Express

Card #: ______________________________________________

Name on card: ______________________ Expiry Date:___________________ Signature: _____________________________

(NOTE: Final registration acceptance is at the sole discretion of the OMFRC Committee Chairperson and will be based upon, but not limited
to: Number of teams per geographical area so as to ensure the largest possible representation from all regions of the province and maximum number of teams permitted due to logistical requirements.)