RMMHA PLACEMENT APPEAL
Parent's Name
*
First Name
Last Name
Athlete's Name
*
First Name
Last Name
Division
*
Please Select
U11
U13
U15
U18
Address
*
Street Address
Unit
City
Province
Postal Code
Email
*
ENSURE THERE ARE NO TYPOS!
Home Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Appeal
*
Fee
*
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PLACEMENT REVIEW FEE
Includes Stripe processing fees
$206.00 CAD
$
206.00
CAD
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
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