Schomberg Minor Hockey Association

Schomberg Minor Hockey Association

REQUEST FOR REFUND

Please complete the following form and mail to:

Schomberg Minor Hockey Association

P.O. Box 145

Schomberg, Ontario

L0G 1T0

Att: Treasurer

I wish to request a refund for:

(please print player name)

who stopped playing in the Schomberg Minor Hockey Association on:

Date: ______________________________ Age Level: ____________________________

Team: ___________________________________________________________________

This may be verified by contacting the following Official associated with the team: Official: _________________________________              Position: _______________________

Phone: ___________________________________

Reason for leaving the S.M.H.A

__________________________________________________________________________________________________________________________________________________

Please send the refund cheque to:

Name: ___________________________________________________________________

Address: _________________________________________________________________

Date: __________________________________              Phone: _________________________

Signed: ________________________________

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