Chicago Mission AAA Hockey Registration Form 02/11/2013 09:39 AM

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IMPORTANT You must register with USA Hockey for the 2011-12 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:}   

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

^{Gender:   Male      Female}

^{Phone #1:          Phone #2:             Phone #3:}  

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

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

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^{Registration for:  Spring '12}          Birth Year 2003-04 2002 2001 2000 1999 1998 Midget Minor U16 Midget Major U18 Girls U12-U14 Girls U16-U19

^{Last Years Team:         Last Years Coach:}       

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

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