Apply to host a game • New York Rangers Assist Benefit Alumni Hockey Games

Your Contact Information

Name*

First Last

Email*

Phone*

Position with Organization*

i.e. President, Board Member, Parent, etc.

Are you a registered 501c(3) program?*

You must be a registered 501c(3) organization to qualify for this program.

Legal Name of Charity*

Name of team (if different from charity name)*

EIN (Tax ID number)

Address*

Street Address Address Line 2 City State ZIP Code

Home Rink

Is your rink publicly or privately owned?*

Are you a USA Hockey registered program?*

Total number of youth players in your organization*

What age groups do you field?

select all that apply

Do you have any all girls teams?

select all that apply

Tell us about your organization*

How will the funds be used?*

Comments / Additional information about your organization, program, rink or needs?

Name

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