NORTH ATLANTIC FIGURE SKATING CLUB

MEMBERSHIP APPLICATION 2007-2008 HOME CLUB COACH

Family Name:    USFS#: ______________________

Address:               

Telephone (H):     Primary E-mail: __________________________________________________

Would you like your name, address listed in NAFSC directory (Y/N)? Would you like to ice monitor or volunteer?  (Y/N)?

USFS#: ____________________                   Name: ___________________________________________________

D.O.B.    Gender:      Work Tel

E-Mail:  _______________________________________

Home Club:  North Atlantic FSC                      Coach/Skater/Nonskater?:___________    USA Citizen?: _______

Have you ever participated in any unsanctioned shows/events/competitions (Y/N)?:  ______          

USFS#: ____________________                   Name: ___________________________________________________

D.O.B.    Gender:      Work Tel

E-Mail:  _______________________________________

Home Club:  North Atlantic FSC                      Coach/Skater/Nonskater?:___________    USA Citizen?: _______

Have you ever participated in any unsanctioned shows/events/competitions (Y/N)?:  ______ ____________________________________________________________________________________________________________

USFS#: ____________________                   Name: ___________________________________________________

D.O.B.    Gender:      Work Tel

E-Mail:  _______________________________________

Home Club:  North Atlantic FSC                      Coach/Skater/Nonskater?:___________    USA Citizen?: _______

Have you ever participated in any unsanctioned shows/events/competitions (Y/N)?:  ______          

Signature of Applicant or Legal Guardian:    Date:

If there are more additional family members, please include details on a separate sheet.

Calculation of Amount Due:           (all dues are payable with application):

Quantity Type of Membership Cost Amount Due

______  Home Club – Coach                                                               $100                      $

______  Home Club -Additional Family Skating Member              $ 60                       $

______  Home Club - Additional Family Non-Skating Member   $ 20                       $

______    US Figure Skating Rulebook (Required)                        $15                          $              15           

______    USFSA Binders  (Optional)                                              $ 7                           $

  Charitable Donation (Tax Deductible)                                                            $

Total Amount Enclosed:                                           $

(Make Check Payable to: North Atlantic Figure Skating Club.)

Return Complete Form and check payable to NAFSC to NAFSC, Attn:  Terry D’Amato, P.O. Box 6052, Falmouth, ME 04105

Signed Coaches Contracts and Proof of Insurance Must also be on file with NAFSC