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TAMPA BAY SURGE
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Personal Information
First name
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Last name
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Phone
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Email
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City, State
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Hockey Information
USA Hockey #
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Do you currently play?
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Yes
No
If yes, which league(s) and division(s)?
How many years have you been playing?
*
What's your highest level of play?
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Desired Position
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Secondary Position
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Additional Comments
Signature
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Date
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Month
Day
Year
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