Chicago Mission AAA Hockey Registration Form 05/15/2012 09:03 AM

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IMPORTANT You must register with USA Hockey for the 2012-13 season before completing this registration form. Click Here if you have not already registered with USAH for the 2011-12 season.

^{USA Hockey Registration Number:}   ***MUST HAVE TO CONTINUE**

^{Last Name:    First Name:   MI:}  

^{Address:    
City:              State:       Zip:   (no dashes)}

^{Date of Birth:}   (enter with slashes   mm/dd/yyyy)

^{Gender:   Male      Female}

^{Phone #1:          Phone #2:             Phone #3:}  
                           (no spaces, slashes or parenthesis ("1234567890") 

^{Parent/Guardian    First Name:   Last Name:}  

^{E-Mail Address:      
E-Mail Address:}      

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^{Registration for:   Fall '12-'13}       Birth Year 2002 2001 2000 1999 1998 Midget Minor U16 Midget Major U18 Girls U12 Girls U14 Girls U16 Girls U19

^{Last Years Team:         Last Years Coach:}       

^{Primary Position: Forward      Defense   Goaltender                         Shot / Catch:   Right      Left}

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