OTTAWA   MYERS   RIDERS

PLAYER   REGISTRATION   FORM

(Please make sure all information is legible)

 

 LAST NAME: _________________________________________________________________  

 

 FIRST NAME: _________________________________________________________________  

 

 HOME ADDRESS: _____________________________________________________________  

 

CITY: ___________________________________ POSTAL CODE: ______________________  

 

 TELEPHONE - HOME: (______)__________________ CELL: (______) __________________  

 

 DATE OF BIRTH: DAY _________ MONTH _____________________ YEAR ____________  

 

 PLAYER E-MAIL ADDRESS: ____________________________________________________

 

 WEIGHT: ___________________________  HEIGHT: ________________________________  

 

 ======================================================================

 

 NAME OF LAST YEAR'S TEAM: ________________________________________________  

 

 HIGH SCHOOL / UNIVERSITY NAME: ___________________________________________  

 

 PREVIOUS POSITION PLAYED: ________________________________________________  

 

 POSITION YOU WOULD LIKE TO TRY-OUT FOR:  _______________________________  

 

 ======================================================================

 

 PLACE OF WORK: _____________________________________________________________

 

WORK  TELEPHONE : (_____)___________________  

 

 ======================================================================

 

 EMERGENCY CONTACT NAME: ________________________________________________  

 

 EMERGENCY CONTACT  TEL: (_____)_______________  CELL: (______) ______________ 

 

 CONTACT E-MAIL ADDRESS: ___________________________________________________