Register for the BPHL Winter 2016-2017

The registration fee is $495.00. This includes ice time, jerseys, and year end party. Games will be on Monday and Thursday nights at Ralston Sports and Event Center. The first game will be on Monday night October 17th.
Please mail this registration form and the fee to here:
Brian Maher
3411 S. 81st Ave.
Omaha, ne. 68124

Make all checks payable to BPHL. Now accepting VISA and MasterCard.

Name (Please Print)
Address (Please Print)
City,                                                    State,      Zip
_________________________________ ________ ________________
Phone #:___________________________________________
Work Phone #:___________________________________________
Cell Phone #:___________________________________________
E-mail: (Please Print)__________________________________________________

Now Accepting VISA and MasterCard

Name on Card (if different than above)

_______________________________Signature: _____________________________ 

Billing Address (if different than above)


City                                                             State           Zip
_________________________________  ________  ________________

Card Number                                              Expiration Date
_________________________________ _____________________________

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