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Prospective Player Application

Do You Have What It Takes?

 

If you are interested in becoming a member of one of the East Coast's premier hockey organizations please fill out the questions below and you will be contacted by a Hampton Roads Jr. Whalers representative.  Thank you for your interest in the Hampton Roads Jr. Whalers.

Name:
Address:
City:
State:
Zip:
Phone:
DOB:
Height:
Weight:
Position:
Last Team:
Last Coach:
Last Coach Phone:
Additional Comments:
Email Address:

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