Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *EmailConfirm EmailPhone Number *How many teams are you playing on this season? *SelectOneTwoThreeFirst TeamFirst League40+B1B2C1C2C3DFirst Team Name(List "Unassigned" if not known) Second TeamSecond League40+B1B2C1C2C3DSecond Team Name(List "Unassigned" if not known) Third TeamThird League40+B1B2C1C2C3DThird Team Name(List "Unassigned" if not known I agree to the terms and conditions of the payment plan listed below. I also understand that this is an electronic signature. *Yes, I understand and agree Please note: $25 service fee will be included in final payment plan charge. Remaining balance due October 5th, 2020. All players electing to do the payment plan are responsible for making their final payment before the deadline listed above. The Greensboro Ice House does not save and re-process credit cards from the original payment date. Failure to pay balance by the due date listed above may result in a suspension from league play. Payment InformationName (as it appears on your card)Credit Card NumberExpiration DateComments**If you would like to provide card information over the phone, please indicate so in the comments box above. Our admin team will contact you when processing your submission.EmailSubmit