SKATERS ANNUAL REGISTRATION FORM                                                               CAREFULLY
                                                                                                                             PASTE RECENT
1.   Mr. / Mrs. / Miss. _________________ _________________       ____________                                               PHOTOGRAPH
                             Surname         Middle Name            First Name                                                   TO FIT
2.   Representing _____________________________ State / U.T _______________
                                                                                                                              WITHIN THIS
     District _________________________ Club / Institution

3.   Occupation ____________________ Date of Birth _____________ (Attach original)
     (Birth Certificates (Including above 16 years) to be sent to Federation, issued by school/College where they are presently
     studying. In case of skaters who have completed their studies, they have to submit valid age proof by way of photocopy of their
     passport / pan card / election commission card / DOB Certificate issued by the Institution last studied)

4.   Present address ___________________________________ Phone : __________________

     & Permanent address _______________________________ Phone : _________________

     Father’s / Husband’s Name ___________________________ Phone : _________________

5.   I started skating in year 20          . My coach is _______________________________________
6.   I participate in Artistic / Speed / Roller - Inline Hockey / General skating
7.   Since I started skating. I have participated in the following No. of Championships:

       Club           Institution     District              State        All India       National     Asians        International
8.   My achievement in Skating _______________________________ (attach details)

9.   I am / was not a registered skater with a State / U.T Unit other than the present one (if you are / were,
     then attach NOC of State/ U.T unit with which you were earlier reged.
                                                       st                        st
10. I attach my annual registration fee for 1 April 2012 to 31 March 2013. Rs. 25/- for Roller Skating
    Fed of India and Rs. 25/- for State/ U.T District Association / Club / Institution Unit.
11. As I am aware that only the RSFI registered skaters are allowed to participate in Internationals, Asians
    and RSFI approved National – All India – Memorial – Invitational Tournaments and the State / U.T
    Units approved State-District & Other local championship, hence I undertake not to participate in any
    competition & / or championship which does not have approval of RSFI & State / U.T.Unit as
    mentioned above.
12. I undertake to abide by all the rules and regulations issued form time to time by Roller Skating
    Federation of India.

     Skater’s                       Approved by                                Date                          Approved by
     Signature                      Club / Institution                                                       District Unit

     (To be filled by Statue/ U.T. Unit)

13. The above particulars have been verified by us and we have received the Annual Registration Fee Rs.
    25/- for the National Federation Rs. 25/- for the State/ U.T / District / Club/ Institution Unit.
14. Recent Passport Size photograph have been affixed on the Form and one extra photo is attached for
    ID card.
15. You may send “Skate News” Bulletin quarterly to the Skater’s Present / Permanent home address.
                                                                    st                          nd                     rd
16. Original of the form is being sent to RSFI, 1 copy to state Unit, 2 copy to District, 3 copy to
    affiliated unit of the District & 4 Copy duly stamped by the state / U.T unit has been returned to the

Skater’s                                                                              Gen. Secretary
Registration No.               Name of State Asso. / U.T. Asso.                       (Affix State / UT Unit Seal/Rubber Stamp
                                                                                      and date)
Note: One receipt of the Form with all annexure and Fee at the State I.U.T. Unit office an identity card shall be
      send to the Skater who must carry the same to be eligible to participate in all RSFI and State IU.T. Unit
      approved championships. Till the identity card is not received the Skater must present the 4 th copy of this
      form to be able to attend the Championship.

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