This questionnaire provides our staff with a better understanding of your commitment and future aspirations. Please take the time to complete regardless if you are interested in playing for our organization.

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First Name *

Last Name *

2021 - 2022 Team *

Month *

Day *

Year *

Position (1st) *

Position (2nd) *

Shot / Catch *

Height (in inches) *

Weight (lbs) *

Mailing Address *

Hometown *

Province / State *

Postal Code *

Country *

Players Email * 🛈

* 🛈

Players Cell *

Are you interested in the Melville Millionaires hockey program ? *

Yes

Why are you interested in the Melville Millionaires hockey program ? *

Are you currently on a Player Protected List in any league ? If "yes", then what team(s) *