RMMHA PLACEMENT APPEAL
Parent's Name
*
First Name
Last Name
Athlete's Name
*
First Name
Last Name
Division
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Please Select
U11
U13
U15
U18
Address
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Email
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ENSURE THERE ARE NO TYPOS!
Home Phone
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Cell Phone
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Reason for Appeal
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Fee
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PLACEMENT REVIEW FEE
Includes Stripe processing fees
$
206.00
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Signature
*
Date
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Month
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Day
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Date
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