Name:________________________ D.O.B.___________________________
Address:______________________ Zip Code:_________________________
Phone (_____)_________________ Hockey Club:______________________
Position:______________________ Grade Next Year:___________________
Make $200.00 Check Payable to C.B.C. Hockey and mail to:
CBC Hockey
10109 Courwick Dr.
St. Louis, MO 63128
If you need further information you may call 481-7171 and ask for John or Matt Jost from 8:00 am - 5:00 pm
Enrollment is limited. Therefore, it is advisable to return your application as soon as possible.