Western Region Ringette - MED Making Ethical Decisions Clinic Registration Form

• For active coaches with CSI 2003 and 2004, all level 1 coaches and level 2 coaches with intentions of proceeding to nationals.
• Clinic will be approximately 3 hours and then participants will have to complete an online evaluation.
• $50.00 per participant to be paid at clinic.
• Limit 25 participants per clinic.
• All participants will require writing material no on ice component
• Register Online - must include the clinic desired and your home association
• Any questions please contact Michael Genereaux or Jodi Walsh at

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Name:		Association	Select Association Chatham Dorchester Elora/Fergus Exeter Forest Goderich Guelph Hanover Independant Kitchener London Mitchell Owen Sound Ripley Seaforth St. Clements St. Jacobs St. Marys St. Thomas Stratford S.W.I.R.L. Tara Tillsonburg Waterloo Wellington North Woolwich Other - Out of Region
Email:		Phone Number

ORA Number if known

Clinic Requested

Select from the following clinics Jan. 6, 2010 - Goderich Maitland Recreation Centre (Sky Harbour Lounge) 6 - 9 PM Jan. 11, 2010 - St. Marys Pyramid Recreation Centre Meeting room A&B 6 - 9 PM Jan. 13, 2010 - Waterloo RIM Park, Room 202 6 - 9 PM

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