2012 BHSA Beyond Basic Skills Winter Skate
Practice Ice
Burlington Ice Palace, Burlington, MA

Session 1:  8:20am to 8:40am

Session 2:  8:40am to 9:00am

---------------------------------------------------------------------------------------------------------------------------------------

Practice Ice Reservation Form

Skater’s Name:___________________________________________________________________
                          (Please Print)
Telephone # (Home)________________________________(Cell)_____________________________

Sessions will be booked on first come first serve basis
Cost per Session $ 12.00 for 20 minutes

·   NO REFUNDS unless a practice ice is cancelled

·   Sessions can not be held without advance payment

·   No Telephone reservations will be accepted

·    Practice ice may be purchased at the event for $15 (based on availability)

·   Sessions will be limited to 20 skaters

Please circle session you wish to register for on January 14, 2012

Session 1- 8:20 to 8:40am

Session 3- 8:40 to 9:00am

Checks must be payable to BHSA and mail to:Basic Skills Competition Practice Ice
C/O Colleen Smith
2 1/2 Pasho Road,  Billerica, MA 01821

Name__________________________________________________________ Sex ____ Birthdate_____/______/_______
           Last                                                         FirstAddress_______________________________________________________ City ___________________________

State______ Zip______ _________Email Address___________________________________________________________

Office Use Only: Date Rec’d_______________________ Amount _____________________Payment Type_____________________________ _