WESTLAND FIGURE SKATING CLUB by h1519w

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									                                       Westland Figure Skating Club
                              6210 North Wildwood, Westland, Michigan 48185 (734) 729-4560

                                   USFSA TEST APPLICATION
        Test Date:        /        /

        Name:                                                           USFS #:
        Address:                                                        Phone:
        City                                                            State:              Zip:
        Home Club:                                             Last Test Taken & Date:

                                               Circle One or More Tests
                                                                                             ADULT MOVES
        MOVES IN THE FIELD                            FREESTYLE                              & FREESTYLE

  PRE-PRELIMINARY         $22.00                PRE-PRELIMINARY          $19.00            PRE-BRONZE           $22.00
  PRELIMINARY             $27.00                PRELIMINARY              $22.00            BRONZE               $27.00
  PRE-JUVENILE            $32.00                PRE-JUVENILE             $25.00            SILVER               $32.00
  JUVENILE                $37.00                JUVENILE                 $27.00            GOLD                 $37.00
  INTERMEDIATE            $47.00                INTERMEDIATE             $32.00
  NOVICE                  $52.00                NOVICE                   $37.00
  JUNIOR                  $57.00                JUNIOR                   $47.00
  SENIOR                  $67.00                SENIOR                   $52.00
            Make check(s) payable to: Westland Figure Skating Club                         (Check #                 )
                    TEST DESCRIPTION                        Fees
                                                                 $           .00
                                                                 $           .00
                                                                 $           .00

                   Practice Ice (If Available)                  $           8.00
                   Judges: Mileage / Expenses                    $         12.00

                              TOTAL                              $           .00

All applications are due 14 days prior to test date. Applications must be filled out completely with exact amount of test fees
enclosed and submitted to the Test Chairperson.         NO LATE APPLICATIONS WILL BE ACCEPTED!!!
                                                                  NO REFUNDS! (Illness or injury may be excepted.)


CERTIFICATION OF SKATER TESTING AT ANOTHER CLUB: The applicant named above is a member in
good standing with the Home Club noted and is eligible to take USFSA test(s) requested above.
HOME CLUB TEST CHAIRPERSON OR OFFICER                                    DATE:          /     /

PARENT SIGNATURE:                                          PRO SIGNATURE:
            Email:                                                 Email:
                                                                    Phone:
Submit application to:
Test Chairperson:                              Or   WFSC Drop Box at Mike Modano Ice Arena
David Petzel
8714 N. Farmington Rd.
Westland, MI 48185-1406
Ph. (734) 525-1784
Date submitted:                        Late:          Judges Exp.:                       Ref.: Aplicant_Master 09.doc

								
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