2016 – 2017 CENTER ICE SKATING CLUB

SESSION REGISTRATION FORM

MEMBERSHIP TYPE:

Please circle membership desired

Full Club Member/Skating, Collegiate, & Non-Skating
(Does NOT include USFSA fee)

$90 Skating/$70 Additional Family Member Skating/$15 Non-Skating

Associate Member (Does NOT hold Center Ice as Home Club) May walk on sessions at the Walk-On Rate. $90

Professional Member/Coaches (Does NOT include USFSA Renewal) $40

Associate Professional Member (Does NOT hold Center Ice as Home Club) $45

         **Refer to Club Bylaws for detailed description of Membership Types**

Skater’s Last Name:______________________   First Name:_________________  Birth Date: ___________

Parent’s Name(s): __________________________________  email: _______________________________

Address:  _____________________________________ City:__________________ State:____ Zip:_______

Contact Phone #:(_____)_____________________    Additional Phone #: (______)____________________

USFSA #: ______________________    Home Club :____________________________________________

Coach’s Name(s):________________________________________________________________________

Highest Free Skate Test Level Passed:_______________________