Mississauga Roller Hockey Association

2011 Mississauga Roller Hockey Association
Registration Form - Youth Divisions

Player's Name
Parent/Guardian Name(s)
Street Address
City, Province, Postal Code
Email Address
Home Phone Number
Cell Number
Emergency Contact Name
Emergency Contact Phone Number
Date of Birth
Sex
Allergies/Health Problems
Most Recent Ice Hockey Experience (select one):
Position (Select One)
Date

The cost per player is $200, $150 for goaltenders (plus HST). Please make cheques payable to M.R.H.A.
Payment can either be mailed or arrangements can be made to meet prior to April 15th.
Mail to: MRHA, 700 Humberwood Blvd. Apt, 2618, Etobicoke, Ontario M9W7J4

2011 Mississauga Roller Hockey Association Registration Form - Youth Divisions

2011 Mississauga Roller Hockey Association
Registration Form - Youth Divisions