American Regionals > 2022-2023 > Mid-Am Region > Fort Wayne Regional > Fort Wayne Registration 2022 (International Silver Stick)

Print Fort Wayne Registration 2022

This registration form will submit your team information for acceptance to the Silver Stick Fort Wayne Regional. You will be contacted via email once you are accepted and placed in one of the divisions.
Please provide accurate information to avoid errors and reassignment/cancellation of division placement.

Team Information

Divison^*

Please Select Division your team is requesting for the Fort Wayne Regional
Team Name^*

"PSM Fort Wayne Force U14 " etc...
Home Branch/League^*

Select one please
Division Justification

Please provide detailed team information (Home league placement, past team placement, etc). Justify your requested division placement for the Fort Wayne Regional.

Payment Method

Please indicate your team method of payment. Registration Approval

Method of Payment:
Mail CheckCredit/Debit (3% fee)
Choose payment method

Contact Information

Please enter contact information for your team. This is how we will communicate information with your team.

Manager Name^*

This will be the Main contact for all correspondence.
Manager Email Address^*

Example: yo[email protected]. Your submission will be sent to this address.
Manager Phone Number^*

Mobile number preferred
Manager Alternate Number^*

Example: ###-###-#### x###
Head Coach Name^*
Head Coach Email^*

Example: [email protected]
Head Coach Phone Number^*

Mobile Number Preferred

Pay to the Order of: FWYH - Silver Stick

Payment must be mailed to:
Fort Wayne Amateur Hockey Association
SilverStick Regional
8136 Mystic Drive
Fort Wayne, IN 46835

Squirt U10- $1125
PeeWee U12- $1175
Bantam U14- $1225

If you chose Credit/Debit, an invoice will be created and sent to the manger email provided. A non-refundable service charge will be added to the registration fee.

Human Validation

Check The Box ^*