Page 1 of 4

WCHL Preliminary Roster Form

Team Name

*

Conference

*

Conference

A

North

B

South

Requested Division

*

Club Contact

*

Club Email

*

Club Phone Number

*

Club Website

Team Contact #1

Team Contact #1 Email

Team Contact #1 Phone Number

Team Contact #2

Team Contact #2 Email

Team Contact #2 Phone Number

Home Rink 1

*

*

Home Rink 2