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)    


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Keep the following information confidential ( i.e.  do not publish in MCFSC Directory) Circle all the apply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



Parent Member                                    $27.00                                                 $25.00




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

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