Central Coast Rhinos Ice Hockey

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CONTACT DETAILS

First Name

Last Name

Address

Suburb

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Postcode

Country

Home Phone

Work Phone

Ext:

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Email Address

Date of Birth (dd / mm / yyyy)

HISTORY (Please select all that apply):

Never Played	Playing In-line	Playing	Used to Play
Coaches - Certified	Has Coached	Goaly	Left Handed
Right Handed	Forward	Defence	Parent

INTERESTS (Please select all that apply):

Administration	Playing	Coaching	On Ice Official
Off Ice Official	Team Management	Club Management	Sponsorship

Notes