2025 Manual Refund Request Form - Hockey Victoria

This form is to request a refund for the Hockey Victoria State Registration Levy Only.

Please click here to read the Hockey Victoria Refund Policy to determine your eligibility for a refund.

For a refund of the Hockey Australia portion of the levy please click here or contact HA via email: justina.balch@hockey.org.au.

This form is to request a refund for Hockey Victoria State Registration Levy Only.

Name of the individual submitting this refund request*

Email of the individual submitting this refund request*

Member Details

Name of Member*

Members Email*

Members phone number*

Members National ID Number

Refund Information

Reason for refund*

Registration type the member is registered with*

(e.g., Junior, Senior, Senior 5 Game, Junior 5 Game etc.)

Members Registration Date*

Refund amount*

How many games have you or the person the refund is for, played this season?*

Bank Information of the individual receiving the refund

Your bank details are required to process your refund if approved. Please ensure you enter your bank details correctly.

Account Name*

BSB*

Account Number*

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