Information sur la joueuse / Player information
Nom de famille / Last Name *
Your answer
Prénom / First Name *
Your answer
Adresse / Address *
Your answer
Ville / City *
Your answer
Code postal / Postal Code *
Your answer
# Carte d’assurance-maladie / Medicare Card # *
Your answer
Expiration Carte / Card *
MM
/
DD
/
YYYY
Date de naissance / Date of birth *
MM
/
DD
/
YYYY
# Carte-Loisirs / Carte-Loisirs #
Your answer
Expiration Carte-Loisirs
MM
/
DD
/
YYYY
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