ApplicationNashville Figure Skating,Figure Skating,Centenial Sportsplex,Nashville Skate,Music City Figure Skating,MCFSC
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Music City Figure Skating Club

 

July 1, 2007- June 30, 2008

 

Member Name:________________________________

__USFS#________________                                                                                                                         (if applicable)    

Address______________________________________________________

City, State, Zip

Email address  _______________________________________________________________

 

Home Phone (_____) ________________            Cell  Phone(_____)___________________    

 

Date of Birth___/___/______   Female  /  Male                          US Citizen Yes  /  No

circle                                                        circle

Coach of Record ______________________________

 

Skating Level_____________________

                                  (if applicable)

     

Membership status (circle one) :   Home club Member          Non Home Club Member

 

Member of another skating club (specify) ____________________  or individual member of USFS

 

Home Rink:   Centennial     Southern Ice   Other(specify)__________________

Circle one

 

Primary Activity :   Parent/Guardian,  Coach,  Competitive Skater,   Recreational Skater Other_______________

 

Circle others that apply :  Adult Skater    Synchro    Collegiate   Competitive Skater   Recreational skater

Test Skater   USFA official/ officer    Coach    Parent/ Guardian    Club Officer/Board Member    Volunteer

Circle one

Parent (if under 18 years old) __________________________________

 

Work Phone (_____) ________________ Cell Phone(_____)_______________    

 

Parent (if under 18 years old):__________________________________

 

Work Phone (_____) ________________ Cell Phone(_____)_______________

   

Additional Family Members (list)

 

name        date of birth                                                                                           name        date of birth

 

 

name        date of birth                                                                                           name        date of birth

 

 

Emergency Contact: Name________________________

Home Phone (____)__________________

Work Phone (_____) _______________

 

Keep the following information confidential ( i.e.  do not publish in MCFSC Directory) Circle all the apply

 

          Home address         Home phone     Work Address              Email Address   

             

Please make checks payable to the Music City Figure Skating Club.

 

Mail to : Music City Figure Skating Club

c/o Carrie Moeller 

184 Forest Trail Drive

 Brentwood, TN 37027 

See below for membership fees                   Total Amount Included $______________

 

 

                                                 Home Club Member                     Non-home Club member

 

First Member in household                    $80.00                                                 $55.00

 

Each additional member                        $37.00                                                 $30.00

   (non-parent)

 

Parent Member                                    $27.00                                                 $25.00

 

 

 

Note: Non- home club membership does NOT include USFS membership.

 
   
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