House League Request For Refund
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Player's First Name *
Player's Last Name *
Player's Age *
Player's Date of Birth *
MM
/
DD
/
YYYY
Division *
Mother's or Father's First & Last Name *
Mother's or Father's Email *
Mother's or Father's Phone *
Invoice Number Issued At Time of Registration *
Paid By Credit Card? *
Reason for request *
Mailing Address-PLEASE INCLUDE POSTAL CODE *
Players Hockey Canada Number *
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