Membership Application 2023-2024
Registration form
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Email *
Player first name *
Player last name *
Date of Birth *
MM
/
DD
/
YYYY
Home Number *
Street Name *
City *
Zip *
Grade for the 2022-2023 school year *
School *
Highest Level of Hockey Played *
How long have you played ice hockey?
Player position *
Jersey # (Please give 3 choices in order of preference) *
Player cell phone
Player e-mail
Parent/Guardian #1  (First & Last Name) *
Parent/Guardian #1   phone *
Parent/Guardian #1   e-mail *
Parent/Guardian #2  (First & Last Name)
Parent/Guardian #2  phone
Parent/Guardian #2  e-mail
Player T-shirt size  (adult) *
A copy of your responses will be emailed to the address you provided.
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