BC Hockey Clinic Hosting Request Form
Applicant Information

Select Season*                        

Name of MHA*
 
Other, if not listed
 
District*
 
MHA Clinic Contact Name*
 
Phone Number*
(posted on Website)
   
Email*
(posted on website)
   
Street*
(NOT posted on website)
 
City*
(NOT posted on website) 		, BC
 
Postal Code*
(NOT posted on website)
 
Clinic Information

Type of Clinic*
 
Month of Proposed Clinic*
  		Number of Days*
Clinic Start Time* Estimated Number of Attendees*
 
Facility Address

Facility Name*
(where to meet)
  		Room
Street Address*
 
City* , BC
  		Postal Code*
 
Billing Information

MHA Billing Address

Street*
 
City* , BC
  		Postal Code*

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