| SEASON: 2004/2005 | 1st October 2004 - 31st September 2005 | |
CLUB/TEAM: ___________________________________________________________ | ||
APPLICANT'S NAME: ____________________________________________________ | ||
ADDRESS: ____________________________________________________________ | ||
_____________________________________________________________ | ||
POST CODE: _________ | TELEPHONE No. _________________ | |
DATE of BIRTH: ___/___/___ | COUNTRY of BIRTH: ________________ | |
NATIONALITY: __________________________ | GENDER: M / F | |
PREVIOUS CLUB/TEAM: ______________________ | YEAR: __________ | |
This application should be dealt with as a dual registration: YES / NO | ||
Currently Registered with: ________________ | Licence No. ____________ | |
I agree to be bound by the rules, regulations and bylaws of the IIHF, BIHA, EIHA Recreation Section and to the club which I am applying. I declare that I am neither the holder of a valid League Licence or playing with a senior league team, and that all the above information is correct. | ||
Applicant's Signature: ____________________ | Date: ____/____/____ | |
| To be Completed by Club Official | ||
I request that the above named be Registered and Insured with the above named club. I enclose with this form the appropriate fee, two endorsed photographs, and a copy of the applicant's birth certificate or passport. | ||
The applicant is a PLAYER/COACH/OFFICIAL/other _____________ | Player Catagory: A/B/C/Z If Coach or Referee, Licence No. __________ |
|
Where the applicant is not G.B. born, I declare that an International Transfer Card is not required. | ||
Signed on behalf of the above club | _______________________ | Date: ___/___/___ |
Name Printed: | _______________________ | |
Position within the club: | _______________________ | |