Name                           

 Date of Birth (mm-dd-yy)                       

Address                 

City                                    

Postal Code                                                      

CARHA insured?          Not insured Insured with NCHL
                                                           

Position                  Select One Forward Defence No Preference Goaltender    

Desired Division - Check all that apply.

                                    Rec Division - No age restrictions      

                                    35 Division - All players must be a minimum of 35 yrs old by Sept 15, 2008

                                    45 Division - Must turn 45 by Mar. 30 of 2009. Goaltenders minimum age 40

                                   55 Division - Must be 54 by Sept 15, 2009. Goaltenders minimum age 50

Phone           Phone 2          

 Email 

Highest Level attained in organized Hockey Select One Professional Major JrA/University JR A, SR A/B Jr. B High School Competitive Minor Recreational Minor