Club Membership Registration Form-Sept. 1, 2007 – June 30, 2007 Mail To: USFIFS, P.O. Box 1970, Bolingbrook, IL 60440 Phone: (708) 707-0992 Fax: (630) 378-9928 Email: info@usfifs.org
Read the information in the instructions on forming a USFIFS club before completing this form
Annual Dues and Fees (Check the appropriate line):
Provisional Club(minimum 3 members)
$15.00
Full Member Club (5 to 15 member registrations)
$15.00
Full Member Club (15 to 29 member registrations)
$30.00
Full Member Club (30 or more member registrations)
$40.00
Upgrade from Provisional to Full Member Club(5 to 15 member registrations)
No Charge
Upgrade from Provisional to Full Member Club(15 to 29 member registrations)
$15.00
Upgrade from Provisional to Full Member Club(30 or more member registrations)
$25.00
Delinquent Club
$5.00
Inactive Club
$5.00
Total Paid = Fill in here
(Note: Fees are reduced by half if they occur after January first)
Make check payable to: United States Federation of Inline Figure Skaters Name of USFIFS Club __________________________________________________USFIFS Club#______________ (Leave blank if new or unknown) Physical StreetAddress ____________________________________________________________________________________________________ Physical City, State, Zip ___________________________________________________________________________________________________ Post Office Address, if different _____________________________________________________________________________________________ Post Office Mailing City, State, Zip, if different_______________________________________________________________________________
If not a U.S. Club, Province, Country and Postal Zone __________________________________________________________________________ Club Contact Name _______________________________________________________________________________________________________ Contact Email Address _____________________________________________ Phone: ________________________________________________ Club Website_____________________________________________________________________________________________________________ Primary Skating Location __________________________________________________________________________________________________ Primary Skating Location Addresss __________________________________________________________________________________________ Club Officers (Officers must certify that they are eligible persons. See the Bylaws and online info.) President ________________________________________________________________________________________________ (Print Name)(Address)(Signature)(USFIFS #) Vice-President (Optional) ____________________________________________________________________________________ (Print Name)(Address)(Signature)(USFIFS #) Secretary ________________________________________________________________________________________________ (Print Name)(Address)(Signature)(USFIFS #) Treasurer ________________________________________________________________________________________________ (Print Name)(Address)(Signature)(USFIFS #) Number of members: ___ Adults (A minimum of 5 members or which 3 officers are adults are needed for a full member club, (A minimum of 3 members are needed for a provisional clubwith no age restrictions) ___ Adult Coaches ___ Youth members ___ Youth coaches You must complete the attached page with a list of members of your club The following is to be signed by the President and Secretary of the club. In the case that the officer is a youth member then a parent or guardian must sign on their behalf. If the applicant club is admitted to the United States Federation of Inline Figure Skaters,otherwise known as USFIFS,it hereby agrees to abide by the rules of the association. It acknowledges that the USFIFS has the right of final determination about the eligibility of clubs and members. The above information is true and accurate to the best of our knowledge. I understand that inline figure skating can be considered an extreme sport. Life threatening injuries can happen even when proper precautions are taken and protective materials are worn. I also understand that USFIFS in not responsible forinjuries caused by participation in the sport.Additional rules may apply in your locality.I further agree that the USFIFS shall be held harmless by any actions of this club and that this club shall be fully responsible for any actions and expenses resulting from any actions of this club. I have read this RELEASE and understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect. Club Name ______________________________________________________________________________________________
Signatures ________________________________________________________________________________________________________ PresidentDate _________________________________________________________________________________________________________ Secretary_________________________________________________________________________________________________________ TreasurerDate Check List: You must do the following: ____ Complete theClub Registration Form (Pg. 1, 2 and 3 of this application) ____ Sign all Forms (Be sure that you have adults sign as officers or have a responsible parent or guardian sign on behalf ofa Youth Member ____ Attach a check for the club level applied for ____ Completed list of club members (Pg. 5 of this application) ____ Membershipapplications for new members (This is a separate form and downloadable from the website). This is not required for non-U.S. clubs Each U.S. member club must also fill out an annual Individual Membership Form, which should be attached to this form or mailed as soon as possible.Feel free to submit your own list with the same info as below. Non-US clubs USFIFS must submit a list for competition, and other benefits. Name of Club __________________________________________________________________________
_____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ ((Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ ((Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ ((Name)(Address)Age(USFIFS#, leave blank if new or unknown) _____________________________________________________________________________________ (Name)(Address)Age(USFIFS#, leave blank if new or unknown) (Use an additional copy of this sheet for more members)
Copyright 2008 - US Inline Figure Skating, US Federation of Inline Figure Skaters For further information contact info@usfifs.org - Send corrections to webmaster@usfifs.org