Board Member Application
2021-2022
First Name *
Last Name *
Address: *
Email: *
Phone Number: *
If you currently have children playing youth hockey, what level will they be in the 2021-2022 season? (Check all that apply) *
Required
Please describe your interest in becoming a board member with the Massena Minor Hockey Association *
Have you been convicted of any crime ( felony or misdemeanor) or do you have any charges currently pending against you? *
Are there any child protective proceedings currently being investigated against you or do you have any findings of Abuse or Neglect? *
Are there any Orders of Protection currently issued against you? *
As a board member of Massena Minor Hockey Association (MMHA), I agree to abide by the rules, regulations, by-laws and policies of USA Hockey, NYSAHA and MMHA. *
Required
I certify, with my electronic signature, that all information provided by me in this application is true to the best of my knowledge. I understand that false or misleading statements made by me of any kind in the application process are sufficient cause for my board member application to be dismissed no matter when discovered. *
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