BMHA 2020-21 Registration Payment form (Brantford Minor Hockey Association)

BMHA 2020-21 Registration Payment form

Please complete this form if you wish to make your registration fee payment by Credit Card. BMHA preferred payment is by Etransfer sent to admin@brantfordminorhockey.com Only player that have paid in full will be allowed on the ice.

Player Information

Name:^*

Required

First and Last

Date of Birth:^*

Required

(mm/dd/yyyy)

BMHA Team played for in 2019-20 season^*

Required

Example: AAA

Contact Information

Name of Parent or Guardian ^*

Required

Phone Number:^*

Required

Example: ###-###-####

E-Mail Address:^*

Required

Example: you@yourdomain.com. Your submission will be sent to this address.

Fee Selection^*

Required

Fee is based on the level the player played in the 2019-20 season

Payment Information^*

Card Type:

Required

Card Number:

Required

Security Code:

Required

Expiry Date:

Month year picker
empty
Jan	Feb	2020	2025
Mar	Apr	2021	2026
May	Jun	2022	2027
Jul	Aug	2023	2028
Sep	Oct	2024	2029
Nov	Dec	<	>

Required

VISA/Debit cards Do not work for this. Must be a Credit Card only.

Multi player payment

list other player you would like to add to this payment.

BMHA 2020-21 Registration Payment form (Brantford Minor Hockey Association)

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Player Information

Contact Information

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