Timekeeper CLINIC NOT REQUIRED ONLY (2018-11-10)

Personal Information
Name*
First Last
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Phone*
Birth Date*
Must be 13 years or older to register for Level 1
Gender*
- Male
- Female

Costs
Binder Required*
- Yes
Cost for Course
Price: $ 20.00 CAD
Do you require a binder?*
- Yes
- No
Binder Cost
Price: $ 0.00 CAD
Total
$ 0.00 CAD
Payment Method
- Cheque
- Credit Card
- Not Required
Please make cheque payable to Hockey WInnipeg and send it to the following address:

Hockey Winnipeg
13-1100 Waverley Street
Winnipeg MB R3T 3X9
Attention: Hailey Dubell
Credit Card

MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Untitled

Timekeeper CLINIC NOT REQUIRED ONLY