2004 Russell Stover Stars Midget AAA Tryout Form

August 6^th-8^th

Name______________________________________________________

Address_____________________City_____________State/Zip____________

Phone_____________________Email________________________

Fathers Name_______________ Mothers Name_________________

Date of Birth_________ Height________ Weight_______

Present Team_________________ Position_______________

Coaches Name_______________ Coaches Number_________________

2003-2004 Stats GP______ Goals_____ Assists_____ Points_______

2002-2003 Stats GP______ Goals_____ Assists_____ Points_______

Future Hockey Goals:___________________________________________

_____________________________________________________________

Method Of Payment:

Check: Made payable to: Russell Stover Stars $60.00

Visa or Mastercard (circle one)

Card Number______________________ Exp __________

Please return tryout form to: Terry Vitali

12613 Stearns

Overland Park, KS 66213

Or Fax to: 913-814-3754 to the Attention of Pat Ferschweiler

Go to www.russellstoverstars.com for team information and updates

Questions: Call Pat at 816-838-3980 or Terry at 913-302-8071

Tryout confirmation will be made by email