1. Player Name *
2. Parent/Guardian Name *
3. Address *
4. City *
5. State *
6. Zip *
7. Email Address (Copy of this form will be sent here) *
8. Phone *
9. Alternate Phone  
10. Player Date of Birth *
    -MM- 1 2 3 4 5 6 7 8 9 10 11 12 /  -DD- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 /  -YYYY- 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
11. Player Gender *
    Male
    Female
    


12. First Year Skater (All first year AYHA skaters 2004 - 1992 will be $75)*
    Yes
    

Fee Chart: (Based on Birth Year)  

1. Learn to Skate 2003 - 2008	$30.00
   2005 - 2006	$65.00
   2003 - 2004	$85.00
   2001 - 2002	$135.00
   1999 - 2000	$140.00
   1992 - 1998	$170.00

4. Payment Method *
   Check (To be received before 1st Practice)
   Credit Card (Paypal invoice will be sent via email)
   
5. Installments *
   Full Payment
   2 Installments (Not Available when paying via Credit Card)
   
6.