CMHA Refund Request

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* 1. Date of Request

Date

Date

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* 2. Player Name

First Name

Last Name

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* 3. Division

U7

U9

U10/11

U12/13

U14/U15

U16

U18

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* 4. Level

House League - Dukes

Competitive - Jr Grads

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* 5. Please select the fee(s) that you would like refunded

CMHA Registration Fee

Jr Grad Tryout Fee

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* 6. Parent Name

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* 7. Mailing Address

Address Line 1 (Street Address, P.O. Box)

Address Line 2 (Apartment, Suite, Floor, etc)

City

Postal Code

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* 8. Phone Number