Register online for the Mid-West Girls Player Development Tryouts
Player Eligibility for 2010: a player must be born in 1996, 1995, 1994, or 1993 to qualify.

Instructions: Complete all fields.  You will receive a confirmation email, so you should double-check
that you enter your email address correctly in the field below.  Send questions to Scott Krueger  or
reply to your confirmation email.

Registration Deadline: March 19, 2010 (walk-up registrations will not be accepted)

Print your confirmation email and mail it along with a check for $75 to:
Mid-West Hockey
C/O Scott Krueger
1601 78th
Clive, Iowa 50325

Select Camp Dates:
March 27-28, 2010 at the Metro Ice Facility, 5100 72nd Street, in Urbandale, Iowa.
Saturday March 27 3:30-5:00 pm
Sunday March 28 9:00-10:30 am
Player Information
Player First Name Date of Birth (mm/dd/yyyy)
/ /
Player Last Name
Mailing Address
City State
E-mail Zip
Height Weight    LBS
Position Trying Out For Shoots
Association
Parent Name
Home Telephone
Work Telephone
Emergency Contact
Emergency Phone  
Coach's Name
Coach's Phone  
Current Team