Arctic Blades FSC Membership Application

Arctic Blades FSC 2008-2009 Membership Application

Please print clearly for application to be processed

Date of Application:_______________ Received by: _______________________

Name of skater:_________________________________________________________

Last Middle First

Address: ______________________________________________________________

City:________________________________________ State:_____________________

Telephone number: Home ( )_____________ Office: ( )____________________

Email Address: ________________________ Age:___________________________

Name of home club:______________________________________________________

Highest test passed: FS_________MIF__________ Pairs__________ Dance_________

Are you a member of any other USFSA club? ___Yes ___No

USFSA membership #:________________ Is Arctic Blades your home club:_______

Attached is my check or money order for dues in the amount of $_______. If my membership application to the Arctic Blades FSC is accepted, I agree to abide by all rules and regulations of the club and support club activities. I understand that the club reserves the right to refuse or cancel any membership and that the club assumes no responsibility for any injury a member may sustain.

_________________________________ ___________________________________

signature of applicant signature of parent or guardian (if under 18)

____________________________________________ ______________________________________________

Active ABFSC Club Member Active Senior Club Member

FEE SCHEDULE:

First Club Member $65

Second family member $45

Second Club Member $40

PLEASE MAKE ALL CHECKS PAYABLE TO ARCTIC BLADES FSC

Mail completed application to:

Arctic Blades FSC Membership

PO Box 3141

Lake Arrowhead, CA 92352