For U14, U16, & U19 GIRLS

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Player Information

^{Name:       Date of Birth:}       

^{Address:  City:} AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA DC WV WI WY ^Zip:   

^{Home Phone#:    Parent Work#:  Cell#:}  

^{Height:      Weight:      Position:}  Forward Defense Goalie *  ^Shot:  Right Left Catch Right (goalie) Catch Left (goalie)    

^{2004-05 Team:            E-Mail:}       

Payment Information:     

^{Payment Method:} Visa American Express MasterCard Check Cash     ^{Amount Due: $250.00}     

^{Card/Check Number: Exp Date:} Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2004 2005 2006 2007 2008 2009

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To pre register, make your check made payable to:
Complete Hockey
 Complete and print this form and mail to:

Complete Hockey Selects
708 Teri Lane
Yorkville, IL 60560

or fax it to 630-553-8992