Application for Membership

Please complete the following information and submit no later than 3 days prior to your interview.

Required = *


Please provide the following contact information:

First Name*
Last Name*  
Street Address*  
Address (cont.)  
City*  
State/Province*  
Zip/Postal Code*  
Country  
Work Phone  
Home Phone*  
Cell Phone
E-mail 1*  
E-mail 2
Date of Birth*
(yyyy/mm/dd)
Emergency Contact*
(Next of Kin)
Emergency Contact Number*

Complete this Section if you are attending school and home address is different from above

Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
Are you a carded OMHA Official? * Yes
No

   
If yes, enter your OMHA Number
   
Enter your OMHA Level
   
Registered or Certified Registered
Certified
   
Are you attending University or College? Yes
No
   
Are you attending High School? * Yes
No
   
Are you currently playing Minor Hockey? * Yes
No
   
Division
   
Are you  playing High School Hockey? * Yes
No
   
School
   
Are you currently coaching Minor Hockey? * Yes
No
   
Division

Note: Everyone must complete a Police Background Check. 
All carded officials from other centres must submit a copy of their current completed Police Check for our records.