Participant Registration Form
First Participant
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
First Participant SignUp
*
Summer Clinic Only
Conditioning Clinic Only
Summer and Conditioning Clinics
USA Hockey #
*
Email
example@example.com
Second Participant
First Name
Last Name
Second Participant Birth Date
-
Month
-
Day
Year
Date
Second Participant SignUp
Summer Clinic Only
Conditioning Clinic Only
Summer and Conditioning Clinics
Second Participant USA Hockey #
Third Participant
First Name
Last Name
Third Participant Birth Date
-
Month
-
Day
Year
Date
Third Participant SignUp
Summer Clinic Only
Conditioning Clinic Only
Summer and Conditioning Clinics
Third Participant USA Hockey #
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Available Clinics
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Pay in Full for Summer Clinic
Pay in full for Summer Clinic 7/16 - 8/27
$
200.00
# of Players
Summer Clinic Deposit
Summer Clinic Deposit Only 7/16 - 8/27
$
100.00
# of Players
Summer Clinic Balance
Summer Clinic Balance Due 7/16 - 8/27
$
100.00
# of Players
Pay in Full Conditioning Clinic
Pay in Full for Conditioning Clinic 8/30 - 9/8
$
120.00
# of Players
Conditioning Clinic Deposit
Conditioning Clinic Deposit Only 8/30 - 9/8
$
50.00
# of Players
Conditioning Clinic Balance
Conditioning Clinic Balance Due 8/30 - 9/8
$
70.00
# of Players
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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