Skater Info Form

XL CENTER
HARTFORD, CT
SATURDAY APRIL 1, 2017
1 - 4 PM

Skater's Name *

First

Last

If applicable - Please list your Dance or Pair Partner's name or if you are skating a small group/duet,etc *

Skater's Date of Birth *

Basic Skills or Full USFS Member? *

Please provide # if you have one *

USFS Club (please state Home Club) or Individual Member? *

Highest Freestyle Test Passed *

Highest Moves in the Field Test Passed *

Highest level Dance Test passed *

If a competitive Dance Team, what level? *

If a competitive Pair Team, what level? *

If skating with a team/group, please list name of group/team(s) *

Select One *

Name *

First

Last

Email *

Select One *

Phone Number *

Skater's Email OPTIONAL *

Additional Email OPTIONAL *

Skater's Cell Phone # OPTIONAL *

Additional Phone Number OPTIONAL *

Please list your song choice if you know it or any additional comments or important information *