Rod Roy Online Registration Form for Snow Camp

1. Fill out the pertinent information.
2. Click the "Submit" button .
3. Print the confirmation page.
4. Pay via credit card by calling (514) 626-6240.
5. Pay via cheque to: (payable to Ski Rod Roy) and mail to:
Ski Rod Roy, 4435 Kingston, Pierrefonds, Quebec, H9A 2T2 (please write the member's name on the cheque).
6. If you require equipment rentals please indicate the following information: height, weight, shoe size.

* Required information
Please email or call (514) 626-6240 if you have any questions or concerns.

Personal Information: Email Address
* 		 
  Family Name
* 		First Name
* 		 
  Date of Birth
* dd/mm/yy

Do you need equipment rentals? Yes or No
*

  
  Street Address (incl. appt #)
 City
  
  Postal Code
 Province
  
  Medicare Number
* 		Medicare Expiry Date
* yyyy/mm 		 
  Home Phone Number
 * 		Work Phone Number
  
  Emergency Contact Person (name & phone number)
Cell Phone Number
  
  Parent's Name
 School / Company
  
details Program (Snow Camp & Ski à la Carte programs only)
* 		Bus Stop
  
Registration Information: I am a...  
 
Former Member of Rod Roy?
 
 
For new members only:
For new members only:
 
 
 
  Are you interested in Terrain Parks? Friend Request - to be in the same class or at the same time as...  
       
 
Program Cost:
Federal Tax  
 
Provincial Tax  
 
Subtotal:
  
 
Discount:
  
 
No:
   
 
Ski Patrol voluntary contribution:
 
 

Grand Total:

 
Method of Payment:
 *  
 
Credit card: Visa & M/C only

 
 
 
 
Referred by:
  
  Comments

I have read and agree to the terms & conditions *

Please check this box if you do not want your name published on web bus lists and class lists.

  
 

n.b. Form tested in Internet Explorer and Netscape 6.0
If you are experiencing difficulties please call (514) 626-6240.

Please submit your registration.