Esso Medals & Certificates of Achievement
Registeration Form

Esso Medals of AchievementBy registering for the program by Febuary 26, 2018 you will be automatically entered for a chance to win one of six $5,000 grants for your minor hockey association and one of six additional $1,000 grants for your team! Every team that is registered for the program will receive one contest entry for the draw. No purchase necessary, see contest rules for details.


This year while the kids are the medalists, the parents and coaches will get a little something of their own. Each team that places an order for medals or certificates will be gifted 20 PRICE PRIVILEGES Fuel Savings Cards* (The value of this card is 5 cents per litre. This card is valid for a savings of 4 cents per litre for you and a donation to the Hockey Canada Foundation of 1 cent per litre, up to a maximum of 100 litres of fuel or until expiry on September 30, 2018, whichever occurs first). These Price Privilege cards will help minor hockey families save on fuel while helping fuel hockey in Canada.


*While supplies last, redeemable in-store only at participating Esso stations in Canada, expires September 30, 2018. Click here for full terms & conditions.


Questions or comments can be directed to the following: info@essomedals.com


To place your order, please fill out the form below as completely as possible. All fields marked with an asterisk (*) are required.


Please Note: You may use this form to place orders for more than one team. Simply enter all of your team names in the "Team/Association" field and then enter/adjust your order quantities accordingly. Each team listed will receive one entry for the Esso Medals Score Big contest.


*Esso and PRICE PRIVILEGES are trademarks of Imperial Oil Limited.

*Please note that by registering for the program by February 26, 2018 you will be entered for a chance to win one of six $5,000 Esso Medals grants for your minor hockey association and one of the six additional $1,000 prizes for your team! Every team that is registered for the program will receive one contest entry for the draw. See contest rules for details.


Questions or comments can be directed to the following: essomedals@hockeycanada.ca


To register, please fill out the form below as completely as possible. All fields marked with an asterisk (*) are required.


Please Note: You may use this form to register for more than one team. Simply enter all of your team names in the "Team/Association" field and then enter/adjust your order quantities accordingly. Each team listed will receive one entry for the Esso Medals Score Big contest, but there is a limit of one entry per team, and that limit applies even if a team is entered more than once.


Team Info

Team / association *

Age group *
If 'other' above:


Shipping address *


Shipments will not be sent to P.O. Boxes

Province *

City / town *

Postal code *

Website

Team gender *

Team Contact Info

Contact Name *


(First name)

 *


(Last name)

Contact Phone#1 *

(xxx-xxx-xxxx)

Contact Phone#2

(xxx-xxx-xxxx)

Contact Email Address *

Contact Role *


If 'other' above:





Order Information

Please Note: A standard team order consists of:

  • 1 set of 3 medals (Most Sportsmanlike, Most Dedicated, Most Improved)
  • 1 set of 18 certificates

No Rush orders. Shipments will begin October, 2017 and delivery will take 6-8 weeks (medals and certificates available while supplies last).

      Please indicate your preferred order quantities below:

Number of teams for which you are ordering: *

NOTE - If you are ordering for more than one team, please list all teams in the 'additional comments' section below.


Please send me the following quantities:

 

English

Medal Sets (3 per set)

 

Certificate Sets (18 per set)

French

Medal Sets (3 per set)

 

Certificate Sets (18 per set)

Additional comments

 

( * denotes required fields )