(All of these hotels are just minutes from the M.A.C. Arena)
First Name: Last Name:
Address:
City: State: AL AK AZ AR CA CO CT DE FL HI ID IL IA KS KY LA ME MD MA MI MN MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code:
Country of Citizenship:
Phone: Fax: Email:
Height: Weight: Date of Birth:
Father's Name: Occupation:
Mother's Name: Occupation:
Do you have any pre-existing medical conditions? No Yes
If yes, please explain:
ATHLETIC INFORMATION:
Current Team: League:
Position: Select Right Wing Left Wing Center Defense Goalie Shoot: Select Right Left
Coach's Name: Coach's Phone Number:
Teams You've Played for in the Last 2 Years:
Year: Team: GP G (GAA) A(Save%) PIM (W/L)
Other Sports You've Played:
ACADEMIC INFORMATION:
Name of High School: Year of Graduation: GPA:
Desired University's: 1. 2. 3.
