HMHC
Out of Town Application
Out of Town Applicant Information
First Name:*
Last Name:*
Address:*
City:*
Province:*
Postal Code:*
Home Phone:*
Work Phone:
E-mail:* Fax:
* Mandatory    
Clinic Request Information
City and League Name:
Which division?
Team Name:
    
Are you speak out certified?
If yes, which?
PRS Number:
   
Are you a certified coach?
Number:
Are you a certified trainer?
Number:
Clinic Requested:
 
Clinic Date:
 
Application Date:
   
   
PAYMENT MUST BE RECEIVED BEFORE APPLICATION WILL BE PROCESSED.

* Mandatory

PAYMENT MUST BE RECEIVED BEFORE APPLICATION WILL BE PROCESSED.

ALL CANCELLATIONS ARE SUBJECT TO A MINIMUM $25.00 CANCELLATION CHARGE.

ANY CANCELLATION WITH LESS THAN 10 DAYS NOTICE IS SUBJECT TO A $50.00 ADMINISTRATION CHARGE

ANY CANCELLATION WITH LESS THAN 7 DAYS NOTICE , NO REFUND WILL BE GIVEN