Please fill out the application form below and mail it with your check or money order to Hipcheck Magazine, Subscription Dept., 679 Queens Quay West, Toronto, Ontario, Canada, M5V 3A9.

Required Information

Name:          (first) _____________________ (last) _______________________

Address:       _______________________________________ (apt#) _____________

               (city) ______________________ (state/prov.) ________________

               (zip/post code) _____________ (country) ____________________

Phone:   (home) (___)_________  (work) (___)_________  (FAX) (___)_________

Email:   _____________________

Optional Additional Information

Date of Birth: (day) ____ (month) ____ (year) ____    Current Age: ________

Team Name:   ______________________________________________________________

League Name: ______________________________________________________________

Team/League Contact Person:  _________________________ (phone) ____________

               (address) __________________________________________________

Coach's Name: ________________________________________ (phone) ____________

               (address) __________________________________________________

I play these sports (X all that apply):
   ( ) Ice Hockey          Number of Years Playing: ____
   ( ) Roller Hockey       Number of Years Playing: ____
   ( ) Ball Hockey         Number of Years Playing: ____

I am:
   ( ) Male
   ( ) Female