Billet Application

Billet Application Last Name:_______________________________ First: ___________________________ Middle: _________________________ D.O.B.:____________________________ Birthplace:_____________________________ SSN:______________________________ Cellphone Number: ____________________________________ Email Address: _____________________________________ Spouse Last Name:_______________________________ First: ___________________________ Middle: _________________________ D.O.B.:____________________________ Birthplace:_____________________________ SSN:______________________________ Cellphone Number: ____________________________________ Email Address: _____________________________________ Home Address:_________________________________________________________________________________________________ Home Phone Number:_________________________________________________________________________________________ Years in Oregon: __________ Previous Address:_______________________________________________________________ Occupation:_____________________________________________________________________________________________________ Employer’s Name:_____________________________________ Employers’ Address:________________________________ Phone Number:________________________________________ Number of Years Employed: _______________________ If less than three, please list previous employer’s name and address: __________________________________________________________________________________________________________________ Spouse’s Occupation:__________________________________________________________________________________________ Employer’s Name:_____________________________________ Employers’ Address:________________________________ Phone Number:________________________________________ Number of Years Employed: _______________________ If less than three, please list previous employer’s name and address: __________________________________________________________________________________________________________________ Please write a brief explanation of why you would like to billet a Winterhawk: __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________

Family Members Name

Age*

Male/Female

School

Living in the home?

__________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ *If child is 16 years old or older, please provide D.O.B. and SSN Pets:_____________________________________________________________________________________________________________ Family Hobbies/Activities: __________________________________________________________________________________________________________________ Are you a Winterhawks season ticket holder:__________________________ If yes, for how long? _____________ Home Is there a separate room for the player? ______________________ A separate bathroom?____________________ Where is the player’s room?__________________________________________________________________________________ Bathroom?______________________________________________________________________________________________________ Distance from Coliseum/Moda Center: ___________ Distance from Winterhawks Skating Center:________ Distance from SHS:____________________________________________________________________________________________ References Please list three references (non-family members who have known you for at least three years) whom we may contact: Name

Address

Phone

Relationship

__________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________

Please send application to [email protected]