Hookin2Hockey - Program Registration

Program/Centre Name *

State/Territory *

Affiliated Club/Association (type N/A if privately run) *

Coordinator Name *

First Name Last Name

Coordinator Phone Number *

Coordinator Email Address *

Program name if different to club/centre

Program Location *

Postal Address (if different to above) ** Please note: This address Cannot be a PO BOX

Club/Program Website

Program Start Date/Time *

- Day - Month Year

at

: Hour Minutes

How many free promotional flyers would you like for your program?

Any additional information you would like added to your promotional flyers:

0/243

Terms and Conditions *

By registering your centre online, you are agreeing to the following Terms and Conditions. http://hookin2hockey.com.au/terms-and-conditions/