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Player Name

Date of Birth

Phone

Address

City State    

Zip

Position

Payment Type Credit Card Type

Card Holder Name

Type Name

CC#

Expiry Date

Amount

Email Address

Make Check of $299.00 Payable to: Hockey Educational Systems

Mail, Fax or E-mail To: Information: 425-218-3246   

Fax # 425-823-1367        kingsgatearena@snokinghockey.com