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DVD or USB Stick
Game or performance recorded with multi-camera High Definition System.
Standard DVD is $25, on USB stick is $35
Please add $8 shipping (unless you can pickup at the Dix Hills Rink Office)

Please do not enter information more than once as you will be charged a second time.

Payment may be made by credit card (see below) or check mailed to:
Long Island Rebels
PO Box 1041
Huntington NY 11743
Name
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Street Address
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Town, State and Zip
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Telephone
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E-mail contact
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Your Team Name
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Your Opponents Team Name
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Game Date
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Game Time
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Game Level if other please give details
Standard DVD or HD USB Stick Choose One
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Name on Credit Card
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Card Billing Street Address
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Town
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Zip Code
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Card Type
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Card Number
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Exp Date
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Code from rear of card
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Video equipment and recording by the Long Island Rebels Youth Hockey Association.
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