Tel: (204) 925-5668 200 Main Street, e-mail:info@mbbroomball.com
Fax: (204) 925-5703 Winnipeg, MB R3C 4M2 Website:www.mbbroomball.com
Toll Free in Manitoba: 1-866-792-7666
PROVINCIAL ENTRY FORM
Membership in the Association does not guarantee any team automatic entry into the provincial championship competition, unless there are less than 16 teams in the division.
Completed entry forms and fees are due in the MABA office by 4 pm January 31st.
Team Name: ________________________________________________________
Contact Person: ______________________________________________________
Telephone: ___________________ E-mail: _______________________________
Juvenile aged 13 - 19: Fee $ 125.00
Boys: ________________ Girls: ________________
Co-ed aged 15 – adult: Fee $ 125.00
A: ____________ B: ___________ C: ____________
Men’s / Women’s 15 – adult Fee $ 250.00
Men’s Contact: ________________ Men’s Non-contact: ________________
Women’s Contact: _______________ Women’s Non-contact: _______________
Aboriginal Co-ed: Fee $ 125.00
Juvenile 13 – 19: ____________ Adult: 15 – adult: _______________
For office use:
Date received: ____________________ Cheque #: _________________