Nominate a Beneficiary
Do you know of a beneficiary from the local hockey community that is in need due to a severe illness or injury?  Please fill out the information below to the best of your ability.  Also, feel free to contact us at to explain further or follow up as needed.  Thank you!
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Email *
Your Name *
First and last name
Your Email Address *
Your Phone number *
Name of Beneficiary that you are nominating *
First and last name
When was this person's date of injury? *
Please give us as much information as you can about the nature of the injury/illness that your nominee has suffered from and the financial impacts that they are currently facing. *
Tell us a little bit about the urgency of the need for assistance for this nominee *
What type of assistance are you seeking for this nominee at this time?
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