Registration Refund Request 2022-2023 (BLOMHA)
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Registration Refund Request 2022-2023
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Registration Refund Request 2022-2023
Refund Details
Please be as concise as possible.
Please state the reason for this registration refund request
*
YOUR First and Last Name
*
NAME OF PERSON CHEQUE TO BE PAID TO
Street Address
*
ADDRESS WHERE CHEQUE TO BE MAILED
City
*
Postal Code
*
Email Address
*
Example:
[email protected]
Your submission will be sent to this address.
Telephone Number
*
Example: ###-###-####
Participant Information
Player First and Last Name
*
Player Birth Year
*
Division + Team Name
*
e.g., U12 Leafs or U12 MD White
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again