Required Fields in Bold.

First Name:

Last Name:

Address:

Home Phone:

Cell Phone:

Email:

Birthdate:

Social Security No:

Height:

Weight:
 

Current School:
 

Current School's Address:

Current School's Phone No:

Current GPA:
 

Have You Applied To WMU:
 

Month / Year Expected To Enter WMU:
 

Intended Major:

Have You Ever Registered With An
ACHA or NCAA Team:
 

Position:
 

Shoot (Right / Left):

Catch (Right / Left):

Current Team:
 

Current Level
(USHL, NAHL, AAA, Etc):
 

Statistics
(Games Played / Goals / Assists / Points):

Goaltender Statistics
(Games Played / Minutes / GAA / Save %):

Current Coach's Name:
 

Current Coach's Phone No: