Applicants Personal Details

 

First Name: ....................................................

Middle Name(s): .............................................

Surname: ......................................................

Address: .......................................................

Address: .......................................................

County: ........................................................

Post Code: ...................................................

Date of Birth: ...................................

Gender: Male / Female

Nationality: ......................................

A  Never Played Before or Rec Only
B  Juniors up to U19 Only
C  Any UK Senior League inc. Women’s
Z  Non UK up to Juniors Only
ZZ  Any Non UK Senior League inc. Women’s

Coach Licence Number: ....................... (If Applicable)

Applicants Agreement

 

I agree to be bound by the rules, regulations and by-laws of the IIHF, EIHA, EIHA Rec. Section and the club to which I am applying.
I declare that I am not the holder of a valid League Licence* and that all of the above information is correct.
(* Unless also supplying a Licence Holder Permission Form from a Women's Team)

..................................... .............................

 

Declaration To Be Completed by either Club Contact

 

I request that the above named player be registered and insured with the above named Club.
I enclose with this form; A Passport Style Photograph (if electronic filename = 'surname'.jpg) and a copy of either their;
Birth Certificate or Passport or Driving Licence, as proof of ID
Where the applicant is not GB born, I declare that an International Transfer card is not required

* If applicant is a Coach, ensure Licence number is Current before applying for the one 'Free' Rec Registration

* If this is not the applicants initial application ensure a full fee payment registration has already been processed

 

Payment to be made by Internet Transfer from your Club Named Account ONLY
1st Team Registration - £50 (£45 With AGM) / 2nd Team - £35 / 3rd Team - £35


Club Manager


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Game Coordinator


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