ENGLISH ICE HOCKEY ASSOCIATION RECREATIONAL SECTION

PLAYER REGISTRATION APPLICATION (PRA 1.9/10)

Completed Forms inc. Photos, ID and Payment must be sent to: Ron Christison 37 Hudspeth Crescent Pity Me Durham DH1 5DZ

SEASON: 2009/2010 1st October 2009 - 30th September 2010
CLUB/TEAM:

Applicants Personal / Club details

First Name:
Middle Name:
Surname:
Address 1:
Address 2:
Address 3:
Post Code:
Telephone No:
Date of Birth:
Gender:
Nationality:
Player Category:
(Circle as appropriate)

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

Previous Club/Team:

Year:
Level:

Most Recent Club played for, can be League or Rec, but Level must be included, i.e. U10, U19, WPL, ENL, REC etc

Coaches Licence No: (If Applicable)

Ensure Applicants Coaching Licence is Current, before applying for a Rec Players Licence. Only ONE Free Team Registration allowed

Rec Team Currently Registered with:

Licence No:

Ensure Applicant Primary Licence is Current before applying for a Multi Team Licence. Maximum of three teams

Applicants Agreement

I agree to be bound by the rules, regulations and by-laws of the IIHF, EIHA and the EIHA Recreational Section, and the club to which I am applying. I declare that I am neither the holder of a valid League Licence*, or playing with a League team, and that all of the above information is correct.
(* Unless also supplying a Licence Holder Permission Form from a Women's Team)

Signature:

Date:

To Be Completed by Club Official

I request that the above named player be registered and insured with the above named Club. I enclose with this form; An Endorsed Passport Style Photograph and a copy of either the Applicants Birth Certificate, Passport or Driving Licence, as proof of ID (and Payment if by Cheque). Where the applicant is not GB born, I declare that an International Transfer card is not required

Payment will be made by: Club Cheque
(Circle as appropriate)
1st Team Registration - £45 (£40 With AGM Attendance)
2nd or 3rd Team - £27

Bank to Bank Transfer
Lloyds: Sort Code 30.96.12
Acc No: 00163602
Transaction Reference - Full Team Name

Team Manager

Name:
Signature:
Date:

Game Coordinator

Name:
Signature:
Date: