Individual 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
Membership Categories & Annual Dues (Check the appropriate line):
___Individual Adult Membership – 18 years and older. $15.00
___Individual Youth Membership under 18 years old (Parent must fill out the parent information below) $15.00
___Adult Coaching Membership (Includes Individual Membership, Fill out this form and Coaching Form) $15.00
___Youth Coach (Under 18 coach, includes individual youth membership. Fill out this form and Coaching Form) $15.00
___Basic Skills Skater (For skaters in the Basic Skills program) $5.00
Make check payable to: United States Federation of Inline Figure Skaters
Skater’s Name __________________________________________________________________USFIFS# _____________________________
(Leave Blank if New or Unknown
Skater’s Address _________________________________________________________________________________________
Skaters City, State, Zip ___________________________________________________________________________________
If not U.S., Appropriate Country, Province or Code ____________________________________________________________
USFIFS Club________________ Skater’s Gender: M or F Date of Birth (mm-dd-yy) _____________
(If a club member)
Contact Email Address _____________________________ Home and/or Contact Phone: _____________________________
Parent’s Name (If under 18) _______________________________________________________________________________
Parent’s Address (if different from skaters) __________________________________________________________________
Parent’s City, State, Zip, Country, Postal Code _______________________________________________________________
Parent’s Appropriate Country, Province or Code ______________________________________________________________
Skating Interests
___Adult Skater
___Coach
___ Parent/Guardian of Skater
___ Synchro Skater
___ Competitive Skater
___ Recreational Skater
___ Other _____________
Competitive and Testing levels in
USARS __________________________ USFS __________________________________
USFIFS __________________________ISI ____________________________________
RSA ____________________________ IIFSA _________________________________
Other _____________________________________________
__ I would like to be considered for the following: Member of Board of Directors, Officer of Board of Directors, Committee Chair, Committee Member or other positions. (Feel free to attach additional sheets or send an email ):
________________________________________________________________________________________________________
The above information is true and accurate to the best of my 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 for injuries caused by participation in the sport. Additional rules may apply where you skate. I further agree to abide by the bylaws and rules of the USFIFS.
Your Signature _______________________________________________________________________________________
Your Parents Signature (if under 18)_______________________________________________________________________
Date: ___________________________________________________
USFIFS Use Only: Check # _____________ Date: __________________ USFIFS #: ______________________
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