Esso Medals & Certificates of Achievement
Registeration Form

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


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.


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 Fax #

(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 17 certificates

No Rush Orders. Minimum 4 week delivery required (medals and certificates available while supplies last).

      Please indicate your preferred order quantities below:

Number of teams for which you are ordering: *


Please send me the following quantities:

  

English

Medal Sets (3 per set)
 

Certificate Sets (17 per set)

French

Medal Sets (3 per set)
 

Certificate Sets (17 per set)

Additional comments
 

( * denotes required fields )