2020-21 Coach/Trainer Rebate Form (Whitby Girls Hockey Association)
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2020-21 Coach/Trainer Rebate Form
Personal Information
Please ensure all contact information is current. This information will be used to mail reimbursement cheques.
First Name
*
Last Name
*
Street Address
*
City
*
Postal Code
*
Primary Contact Telephone Number
*
###-###-####
Email Address
*
An email confirming receipt of your submission will be sent to this address.
Team Information
I am currently a member and/or support staff of the following team:
Division and Team Number
*
Example: HL Tyke (Team 1), Peewee AA etc.
Course Information
Clinic Type you completed
*
Select One...
NCCP Coach
Respect in Sport
HTCP Trainers
Actual Clinic Date
*
Example: October 21 - 22, 2014
Clinic Location
*
Example: Whitby
Cost
*
Method of Payment
*
Cash
Cheque
Credit Card
Please attach a copy of your paid receipt for the clinic
*
Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.
Your application will NOT be considered without this information attached.
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again
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Printed from wgha.org on Saturday, February 27, 2021 at 10:29 AM
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