North Atlantic Figure Skating Club Test Request Form            Monday, November 12^th 8 - 4

Family Ice Center, Hat Trick Dr., Falmouth, ME

TEST FORMS MUST BE MAILED                         APPLICATION DEADLINE: November 5^th, 2007

SKATER  NAME:___________________________     USFSA#___________________

ADDRESS:______________________________CITY__________________STATE______ZIP____

PHONE(___)______________                         HOME CLUB:__________________________

IF HOME CLUB IS OTHER THAN NAFSC, ARE YOU AN ASSOCIATE OF NAFSC?    YES    NO

E-MAIL ADDRESS:______________________________***Schedule will be sent via e-mail***

MOVES IN THE FIELD FREESKATING TESTS ADULT FREESKATE TESTS

_____Pre-Preliminary                              _____Pre-Preliminary ($25.00)               _____PreBronze ($25.00)

_____Preliminary                                     _____Preliminary ($25.00)                      _____Bronze ($35.00)

_____PreJuvenile                                    _____PreJuvenile ($35.00)                     _____Silver ($45.00)

_____Juvenile                                         _____Juvenile ($35.00)                         

_____Intermediate                                 _____Intermediate ($40.00)                

_____Novice                                           _____Novice ($45.00)                                                                                                           

ADULT MOVES TESTS

_____Adult PreBronze                                                                                                                           

_____Adult Bronze                                  ***ALL MOVES IN THE FIELD TESTS ARE $40.00 EACH                                        

_____Adult Silver                                                                                                   

_____Adult Gold                                                                                                                                                     

DANCE TESTS:

Preliminary Silver                     SOLO:  $5/SOLO

___Dutch Waltz                                                       ___American Waltz       Y/N   

___Canasta Tango                                                  ___Silver Tango            Y/N

___Rhythm Blues                                                    ___Rocker Foxtrot        Y/N

($20 1^st test, $15  2^nd & 3^rd each)                           ($35.00 1^st test, $15 2^nd & 3^rd each)

Pre-Bronze                 Pre-Gold                SOLO:  $5/SOLO

___Swing Dance                                                      ___Starlight Waltz          Y/N

___Cha-Cha                                                            ___Paso Doble               Y/N

___Fiesta Tango                                                     ___Killian                        Y/N

($20 1^st test, $15 2^nd & 3^rd each)                            ___Blues                         Y/N

                                                                                ($35.00 1^st test, $15.00 2^nd & 3^rd each)

Bronze                                                                                                                                                  

___Willow Waltz

___Hickory Hoedown                                                                                                               

___Ten-Fox                                                                                                                                            

($20 1^st test, $15 2^nd & 3^rd each)                                                                           

Pre-Silver                                            

Signature- Freestyle Professional:_____________________________               

___14 Step                                                              Signature – Dance Professional:_______________________________              

___European Waltz                                                                

___Foxtrot                                                             

($30 1^st test, $15 2^nd & 3^rd each)                            NAME OF PERSON TAKING YOU THROUGH DANCE TESTS:

                                                                                _____________________________________________

PERMISSION TO TEST:  This certifies that _________________is a member in good standing of ______________________________(club name) for the 2007-2008 membership year and has permission to test on the above date.

***This section MUST be completed prior to testing*** Non-club members must obtain permission from their own test chair.   

Signature of Test Chair:_________________________________Date____________

Signature of Skater (Parent if under 18) ___________________________________Date:_________________

Please send application to: Diane Huntley PO Box 145 Coopers Mills, ME  04341  Questions: huntley@gwi.net/549.5668

Fees:  All skaters add a $7.50 hospitality Fee to the total of test fees.  Non-Member Fee is $30.00  Late Fee is $20.00  Please enclose check for the total amount payable to North Atlantic Figure Skating Club.