CFIHOA Registration form

Please fill out and submit form. This will ensure that our treasurer has the information necessary to process and mail out checks.

There is no fee for new Level 1's. Fees for all others is $30.

Fees will be deducted from your paycheck. You will be notified as to which month this will happen.

You may submit this form online, or print and send it to:
Stephen D. Herman CPA
P.O. Box 7307
Lakeland, FL 33807-7307

Last Name: First Name:

Address:

City: Florida Zip Code:

Home Phone: Work Phone:

Cell Phone: Pager:

Email (home):

Email (work):

Date of Birth: Age:

Social Security Number:

USA Hockey Member #:

Were you registered with CFIHOA for the 08/09 season? Yes No

What level were you last season? 1 2 3 4

What level are you applying for this season? 1 2 3 4