WILMINGTON FIGURE SKATNG CLUB
P.O. BOX 219
WILMINGTON, MA 01887
978-694-9650
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Test Date____/____/____
MOVES IN THE FIELD
Name:_________________________
(as it appears on USFSA card)
USFSA#________________________
Address________________________
_______________________________
Telephone______________________
X______________________________
(Applicant's Signature Age 18 & over)
X______________________________
(Parent's Signature Under Age 18)
X______________________________
(Professional's Signature)
Last Date Tested_____/_____/_____
This is to certify that
___________________________________
is a member in good standing of
___________________________________
and has my permission to test on the above date.
___________________________________
**Test Chairman's Signature
I am a USFSA Individual Member_________
FREESTYLE
Pre-Preliminary
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$25.00_______
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Preliminary
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$25.00_______
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Pre-Juvenile
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$30.00_______
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Juvenile
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$30.00_______
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Intermediate
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$35.00_______
|
Novice
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$35.00_______
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Junior
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$35.00_______
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Senior
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$35.00_______
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Adult Bronze
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$20.00_______
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Adult Silver
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$22.00_______
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Adult Gold
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$24.00_______
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_______________________________
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$____________
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___________________________
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$____________
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Hospitality Fee & Individual USFS Fee
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$ 30.00
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Hospitality Fee & Non-Member Fee
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$ 25.00
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Wilmington FSC Hospitality Fee
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$ 5.00
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Late Fee (if applicable)
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$ 25.00
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Total:
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$
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USFS Individual Members Only
Non-Members Only (representing another USFS Club
Wilmington FSC Members Only
**Test chairman’s signature is required on all applications or they cannot be accepted.
ALL TEST SESSIONS ARE CLOSED – ONLY SKATER & THEIR COACH WILL BE ALLOWED IN RINK AREA
Return Check Fee $25.00
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Pre-Preliminary
|
$30.00______
|
Preliminary
|
$30.00______
|
Pre-Juvenile
|
$30.00______
|
Juvenile
|
$30.00______
|
Intermediate
|
$35.00______
|
Novice
|
$35.00______
|
Junior
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$35.00______
|
Senior
|
$35.00______
|
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