THE SKATING CLUB OF WORCESTER – APPLICATION FOR MEMBERSHIP
2008-2009 SEASON  -  **Renewal Deadline JUNE 1, 2008**

MAKE CHECKS PAYABLE TO THE SKATING CLUB OF WORCESTER

Please check one:        o NEW       o RENEWAL*    	USFS# required if you are a current or recent USFS member

Name:  	 	 	 	 	Date of Birth:  	 		
Address:  	 	 	 	 	USFSA#:  	 		
City:  	 	 	State:  	 	Zip:  	 		
Email Address:  	 	 	 	 	(for skating club & USFS  use only)	
USA Citizen:	Yes  /  No			Phone #:				
								
Parent/Guardian:  	 	 	 	Phone #:  	 	 		
Emergency Contact:  	 	 	 	Phone #:  	 	 		
Professional's Name:  	 	 	 	Phone #:  	 	 		
								
Last Test Passed:  	Moves	 	Freestyle	 	Dance	 		

MEMBERSHIP DESIRED – CHECK ONE
	_____ Home Club Membership	$200.00*
	_____ Family Home Club Membership	$300.00		*IF YOU ARE RENEWING YOUR MEMBERSHIP
	_____ Junior Club Membership	$75.00		THE APPLICATION DEADLINE IS JUNE 1, 2008.
	_____ Collegiate Home Club Membership	$50.00		AFTER JUNE 1ST, THE HOME CLUB MEMBER
	_____ Non Home Club Membership	$100.00		FEE INCREASES TO $250.
	_____ Professional Home Club Membership	$60.00
	_____ Professional Non Home Club Membership	$75.00

All applications for membership are subject to review by the Skating Club of Worcester, Inc. Board of Governors.

Financial / Membership Obligations: 
•	Membership dues are payable with this application and are non-refundable once the application has been approved.
•	Returned checks will be charged $25.00
•	By signing below, I agree to comply with the rules and regulations of United States Figure Skating and the Constitution, Bylaws, and Rules of Ice Conduct of the Skating Club of Worcester.
•	As a Member or Parent/Guardian, I agree to provide a minimum of five(5) hours of my time and five(5) hours of my above named child’s time to the Worcester Open held the latter part of March or the beginning of April.  If we do not, I understand that a penalty may be assessed.  (This does not apply to Non-Home Club Memberships.)
   I have read, understand and agree to all of the above statements:
 
  _____________________________________________________________           _________________________________
   Signature of Skater or Parent/Guardian if under 18 years of age                                Date

Release:
I hereby assume all risks and hazards incidental to my/my child’s participation in any and all Skating Club of Worcester, Inc’s activities.  I hereby waive, release, absolve, indemnify, and agree to hold harmless the Skating Club of Worcester, Inc., its directors, sponsors, supervisors, participants, or professionals, and FMC and its employees, for any claim arising out of injury to me/my child.  If unable to reach parent or guardian, the Skating Club of Worcester, Inc., or its professional staff is granted authority to obtain emergency medical treatment.

  _____________________________________________________________           _________________________________
   Signature of Skater or Parent/Guardian if under 18 years of age                                Date

For official use only:
     Cash:_____  Check#:__________  Postmark Date:__________          o     USFSA          o SCOW