Return one copy of this form
to the Championship Director and one copy to the Executive Director by
October 14, 2005 |
| Field Hockey Committee Chairperson | Executive Director |
| Bridget LaNoir Rensselaer 110 8th Street Troy, NY 12180 518-276- 8623 (W) 518-276-8997 (F) lanoib2@rpi.edu |
Victoria Chun NYSWCAA 7248 Butternut Lane Hamilton, NY 13346 315-824-8911 (P) 315-824-8911 (F) vchun@nyswcaa.org |
| 1. |
Name of Member School
______________________________________ ___
(Please Check only one) WILL _________ WILL NOT ____ compete in the 2005 NYSWCAA FIELD HOCKEY Championship.
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| 2. |
Our College or University
(Please Check only one) WILL _________ WILL NOT ____ host the 2005 NYSWCAA FIELD HOCKEY Championships if we are the highest seed. |
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| 3. |
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| 4. |
Entry Fee of $225.00 is due once you are selected to participate. A $100.00 fine will be imposed for late declarations. If your school decides to withdraw from the tournament, it must be done before "Selection and Seeding" or the penalty will be loss of entry fee and eligibility for the following year's championship. | |
| 5. | Head Coach Name ________________Office Phone _______________________ | |
| 6. | Head Coach - Fax ______________________________________ | |
| 7. | Head Coach - E-mail ____________________________________ | |
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_______________________________________________ NAME OF ATHLETIC DIRECTOR OR VOTING REPRESENTATIVE ______________________________________________________ SIGNATURE OF ATHLETIC DIRECTOR OR VOTING REPRESENTATIVE ______ Yes, I want to be notified if our team has been selected. My Phone number is ________________________ DATE: |
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Last Updated: 08/14/05