2015-2016 CCFSC Membership PDF

Creve Coeur Figure Skating Club
Updated 06/01/2015
2015-2016 Membership Application Form
For the year June 1, 2015 through June 30, 2016
Home Club Membership Associate Membership
All Home Club memberships include one (1) Skating magazine and USFS membership. With the Family Membership, one member
would be designated as receiving the Skating magazine and all would be members of the USFS.
First Name
MI
Street Address
Last Name
Gender
City
Work Phone
Date of Birth (MM/DD/YYYY)
State
Home Phone
Cell Phone
Email Address
USFS# (if any)
Zip Code
U.S. Citizen (Y/N)
Home Club (If joining as an associate member)
Members under 18 years of age are Junior Members. Each HOME CLUB Junior Member will have one parent/guardian as a
member who should complete the following:
Parent/Guardian Name
Work Phone
Address (if different than above)
Cell Phone
USFS# (if any)
Date of Birth (MM/DD/YYYY
Gender
U.S. Citizen (Y/N)
Membership Fees
Membership
Make check payable to: CCFSC
(Please Circle Membership Choice )
Family Membership (1)Skater under 18 years old
Plus (Each Additional Family Member/Skater under 18)
or
Senior Member 18 years or older
Associate Member (Home Club Member of Another Club)
Professional Member
Collegiate Membership (4 year membership)
Supporting Member
USFS Introductory Membership (First Time USFS Member)
Introductory Family Membership - (1) Skater under 18 years old
Introductory Senior Membership - 18 years or older
$115.00
$45.00
$70.00
$70.00
$70.00
$130.00
$110.00
–
Mail to: Ley Fatzinger
1668 Fontana Dr
St. Louis, MO 63146
LFatz@sbcglobal.net
Membership Fee Total:
IF YOU ARE A SKATER AND/OR PLAN TO BE ON
$60.00 THE ICE AT ANY TIME, AN EMERGENCY MEDICAL
$45.00 RELEASE/WAIVER MUST BE COMPLETED AND
TURNED IN AT THE CREVE COEUR RINK.
________
Total Amount Enclosed:
________
–
 Yes, I wish to receive email from CCFSC regarding events,
changes to ice schedule, and reminder notices.
I would be interested in volunteering for:




Hospitality Fund Raising Ice Monitor Competitions
Other:_______________
Acceptance of membership in the Creve Coeur Figure Skating Club subjects the member to all rules and regulations of the club and
requires that each member support club activities. I hereby waive any right to claim damages against the club, its officers,
directors and members, and release any and all of them from any liability that may arise out of my membership therein. I also
hereby give my consent for my skater or myself to be photographed during CCFSC functions and allow posting of photographs in
CCFSC publications, including the CCFSC website, newsletter and ice arena bulletin board and release the Creve Coeur Figure
Skating Club from any liability for their use.
_________________________________________________________
Member’s Signature
Date
________________________________________________________
Parent/Guardian Signature (if member is under 18)
Date