<% @language="vbscript" %> Membership Application                                 The Skating Club of Wilmington's
                            APPLICATION FOR NEW MEMBERSHIP
                                 Please print clearly and fill out completely
                                                 Print this page

Name:

Dr.
Mr.
Mrs.
Ms

____________________________________________________
    Last Name            Legal First Name (and spouse)                Middle Initial

 
Home
Address: 		______________________________________________________
Street                                               City                    State         Zip
 
E-mail address: ___________________________________
Publish e-mail in Member Directory?    ¨ Yes ¨ No
 
Home
Phone:		 Member: (    ) _________ Work Phone: (    ) _________ Cell
Phone:		 (    ) _________
Home
Phone:		 Spouse: (    ) _________ Work Phone: (    ) _________ Cell
Phone:		 (    ) _________
 
Children in Household (under 21 years of age) and birth dates:
  List legal name on left and birthday on right: à               List birth date(s) here:

(1)_____________________________________________à (1)________________________

(2)_____________________________________________à (2)________________________

(3)_____________________________________________à (3)________________________

(4)_____________________________________________à (4)________________________

Check ICE USE FEES Category desired and indicate if Individual (I) or Family Multiple (M).
_____ Member with Walk-on Fee of $13/skater/session
_____ Bronze Use (Up to 15 Sessions/Month
_____ Silver Use (Up to 35 Sessions/Month)
_____ Gold Use (Unlimited Sessions/Month)		 _____ (I) or _____ (M)
_____ (I) or _____ (M)
_____ (I) or _____ (M)

Names of family members who will be skating: _________________________________

_______________________________________________________________________

Business, professions, skills, interests of adult applicant(s): _____________________

_______________________________________________________________________
 
Past association
with SCW:		 _____ Public Session
_____ Guest		 _____ Hockey
_____ Summer School		 _____ Public Lesson
_____ Other
If applicable:
Name(s) of coach(es) who will give private lessons: ____________________________

________________________________________________________________________
Highest USFSA
tests passed:		 Figure: _____________________
Dance: _____________________
Moves in the Field: ___________		 Free Skating: ______________

Pairs: ____________________
________________________________________________________________________
Home Skating Club: ____________________________     USFSA Number: __________
 
If you are transferring from another USFSA Club, please have a club officer or test chairperson send a letter indicating that you are a member in good standing at your home club.
 
I (We) hereby apply for membership in SCW and have included the $145 Member Annual Dues, plus, (if applicable) the first month's payment of any Ice Use Fees category (Bronze, Silver or Gold) chosen.
 
I (We) agree to comply with the rules and by-laws of the Club. (See SCW Handbook and Supplement)
 
I (We), understand that ice skating is a dangerous sport, and hereby waive any claims for damages sustained in the course of ice skating at the Skating Club of Wilmington.


Adult Signature: _____________________ Amount Enclosed: ________ Date: _______