BEGINNER
REGISTRATION FORM P.O. Box 1433, Alameda, CA 94501
1-800-PLAY-PHA Fax: 925-634-7429 e-mail: pha@playpha.com

Name: ___________________________________________________

Address: _________________________________________________

City: __________________ State: ______ Zip: _________________

Home Phone: _______________ Work Phone: _________________ Email: _________________

Please indicate the method of payment enclosed with application: Check ____ Credit Card____

Visa ___ MasterCard ___

Name as it appears on the card: _____________________________________ Exp. Date: __________
(Please Print Clearly)

Amount to Charge: $__________________

Card Number:














For credit card payments:

Please fill out the Registration Form and send it via:

Fax: 925-634-7429 Voice Mail: 1-800-PLAY-PHA Email:pha@playpha.com U.S. Mail: below

For payment by check:

Please fill out the Registration Form and send it via:

Fax: 925-634-7429
Voice Mail: 1-800-PLAY-PHA
Email:pha@pachockey.com

U.S. Mail: See Below

For payment by check:

Please fill out the Registration Form and send it, along with your check made payable to the Pacific Hockey Association or PHA, to:


PHA
P.O. Box 1433
Alameda CA 94501