Student's First Name
Student's Last Name
Birth Date (FIRST, select month, then year, then date)
Order notes (optional)
Email Address *
Email Address: Your receipt and completion certificate will be emailed to the email address you enter in the Participant Information above. If you do not receive either of these emails after submitting your payment, please check your spam or junk mail folder.
Type any 3 letters of Group name and then select Group from listBishop’s University Hockey (Sherbrooke, Quebec)Washington (Pi Kappa Phi)Other
Jurisdiction Name *
Jurisdiction Contact Name / Phone *
Please create an account username and password below. Please store this information somewhere safe so that you may return to your dashboard at any time.
Account username *
Create account password *
First name *
Last name *
Company name (optional)
Phone *
Country / Region *Select a country / region…CanadaUnited States (US) *Update country / region
Address (Please use the address associated with your credit card.) *
Town / City *
State * Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)
ZIP Code *
Prepaid Cards: You may need to call the phone number on your card to activate it before completing online transactions. Please ensure that the address on file matches what you enter in the billing details above.
Card number *
Expiry (MM/YY) *
Card code *
