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Prospective Player Form

Please fill out all areas of the form if you are interested in playing for Elmira!

Elmira Impact Prospective Player Form

First Name: *

Last Name: *

Birth Year (4 digits) *

Position: *

Last Team: *

Your Cell Phone: *

Your Email Address: *

Grade Point Average (GPA) on a 4.0 scale: *

ACT/SAT Scores if taken:

Shoot: *

Left

Right

Goals Scored in how many games with last team: *

Assists Made in how many games with last team: *

Penalty Minutes in how many games with last team: *

Save Percentage with last team: (If Applicable):

Height: *

Weight: *

Name of Last Coach: *

Phone Number of Last Coach: *

Goals/Aspirations: *

What makes you interested in playing in Elmira?

If you are human, leave this field blank.

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