Name ___________________________________________ Home Phone _______________________

Address _________________________________________ Work Phone _______________________

City _______________________ Zip ________________ E-Mail Address ______________________

Date of birth ____/____/____ Social Security # (optional, for USA Hockey) __________________

Registration Fee is $300 if paid in full postmarked by February 23, 2000.  (USA Hockey fees and jersey fees must also be enclosed for discount.) DUES ARE $350 TO BE PAID BY March 8, 2000*.

* A fee of $50 will be due for late registrations after 3/18/2000.

**Splitting players must pay the $25 administrative and $50 pre-season ice fees, in addition to the registration dues (ie. $187.50  for early registration or $212.50 by 3/8, due from each individual.

Registration:   _____Early (before 2/23)     _____Standard    _____Late (after 3/18)          
                                                                                                                                        League Fees enclosed $____________

All new players to the league must purchase home and away jerseys and socks ($70/full set).  Players requesting placement in a new division should not include jersey and sock fees until after placement.
(Jersey numbers may be re-used at the discretion of the league after a player has not registered for 12 months.)

I need new jerseys - $25 per jersey. _____home   _____away                                Jersey fees enclosed $_____________
I need new socks - $10 per pair.       _____home   _____away                                   Sock fees enclosed $______________
For my Division:  _____Green (Beg.)      _____Red (Int.)     _____Blue (Adv.)

USA Hockey membership ($25) required for all new NCWHL players and individuals not registered with USAH September 1999.  If you were registered with the NCWHL for Fall Season, you are already registered for USA Hockey and do not need to pay this fee again.  If registered through another league, indicate league:_____________
                                                                                                                                           USAH fees enclosed $___________

Total fees including total of registration fees + jersey and sock fees (if required) + USAH fees (if required):
                                                                                                                                           Total amount enclosed $___________

Current status in the NCWHL: __Green (Beg.)      __Red (Int.)     _Blue (Adv.)
_____Returning from last season       _____Previous NCWHL Player       _____New to the League

I own NCWHL Jersey number(s) and color(s) _________________

I will be requesting placement in another division level: _____Green (Beg.)      _____Red (Int.)     _____Blue (Adv.)

I only play ____Defense ____Offense ____In goal (Do not mark if you play multiple positions.)

_____I would like to try goaltending (some equipment provided by the league).

Health Insurance Company_____________________________________________________________

Policy number _________________________________ Telephone number _____________________

Please continue completing the information below.  _____I have   _____I have not  read and signed below in 3 places.

Responsibilities: As a member of the Northern California Women's hockey League, I will do all I can to promote the sport of ice hockey; to help myself and others to improve as female athletes; to uphold the ideals of good sportsmanship, teamwork and fair play; and to maintain the integrity of the NCWHL. I also agree to pay all dues and fees to the League in a timely manner for all expenses involved with playing in the NCWHL, including but not limited to: NCWHL registrations, USA Hockey membership, substituting in games, extra practices, pickup games, jerseys and socks. I will read the NCWHL Policy Guide and Rule Book.

Signature__________________________________________________________________Date_________
                    (if under age 18, parent or guardian also must sign.)
Printed Name_______________________________________________________________

NCWHL REFUND POLICY

The Northern California Women's Hockey League is under no obligations to provide refunds of any kind.  In addition, the league can deny membership to players who owe balances for previous seasons.

Players are eligible for partial refunds of requests in writing and only :
Prior to start of season. A player may ask for a refund of dues paid (minus an administrative fee*) if she requests it in writing prior to the start of the season (for the summer season the start date is March 18, 2000).

Prior to team selection. A player may ask for a refund of dues paid (minus and administrative fee and preseason ice fee**) after March 18, 2000 if she requests it in writing prior to teams being selected (the third week of the preseason).

Once teams have been set, refunds-partial or otherwise-will not be granted.
League credits will be issued to players for reasons of injury and pregnancy. The player will not receive any funds. The NCWHL will keep a credit for the individual for one year, to be used for season registration only. The credit will be pro-rated to the date the league treasurer was informed in writing. (Please see the league rules and policies for more information.)
*Administrative fee is $25
** Preseason ice fee is $50

ACCEPTANCE OF TERMS

Acceptance of League Refund Policies. I understand and accept the league refund policy.
Acceptance of League Placement Policies. I understand that, as voted by the members, the NCWHL is placing players in divisions as well as on teams based upon skill level. I will try out at the level where I believe I belong. However, I understand I may be placed in another division. I am willing to play where the league places me.

Assumption of risk: I understand and agree that the sport of ice hockey has inherent risks of physical injury, including serious injury and/or death, and I accept and assume all such risks. I will not hold the NCWHL liable for injury which I may sustain while participating in any League activity. I hereby certify that I have adequate medical insurance to pay for the treatment which may result from my participation in League activities, and I agree to be solely responsible for all medical costs arising from any injuries I may receive while participating in League activities. I further certify that I have no known medical condition which would prohibit me from participating in the sport of ice hockey.

Signature _____________________________________________ Date ______________
                     (if under age 18, parent or guardian also must sign.)

RELEASE OF PERSONAL IMAGE

The NCWHL ____does  ____does not    have my permission to use NCWHL-related photos,  which may include my image, for its website or other marketing materials.

Signature __________________________________________ Date _______________
                       (if under age 18, parent or guardian also must sign.)