Membership Application

July 1, 2017 - June 30, 2018

Personal Information
U.S Figure Skating Member Number
   current members: (enter USFS # first)
*Skater Last Name
*Skater First Name

*Date of Birth (mm/dd/yyyy)

*Gender
Female Male
*U.S. Citizen
Yes No

*Address

*City
*State
*Zip

*Email
Club communication is sent via email; check this box if you would rather receive communication via postal mail:

*Item is required by U.S. Figure Skating.
Home Phone
Work Phone

Parent/Guardian Name (if skater under age 18)

Eligibility Status

Eligible
Ineligible (participated in unsanctioned activity)
Restricted (by reason of employment)
Skating Motivation - Check all that apply

Competitive Skater
Recreational Skater
Adult Skater
Coach
Collegiate Skater
Synchronized Skater
Parent/Guardian
Club Officer/Board Member
U.S. Figure Skating Officer/Official
Other
Highest U.S. Figure Skating Test Passed:

Dance
Freestyle
Moves

Coach

Coach's Name
Coach's Phone

Membership Type - Note: Annual dues are not prorated for a partial year membership.
First Family Member (good for 1 year; includes USFS dues and Skating Magazine)$95.00
Additional Family Member (good for 1 year; includes USFS dues)$55.00
Introductory Membership (good for 1 year; includes USFS dues and Skating Magazine)$60.00
Collegiate Member (good for 4 years; includes USFS dues and Skating Magazine)$160.00
Associate Member (good for 1 year of Starlight membership only)$35.00
      U.S. Figure Skating Home Club (if applying for Associate)

I hereby apply for skating membership in the Starlight Ice Dance Club of the Twin Cities (Starlight). I agree to comply with the Starlight rules, as stated in the bylaws (available at www.starlighticedanceclub.com), when participating in any Starlight activities. I recognize that Starlight has been formed to promote ice dancing. It is understood that Starlight will take reasonable means to provide a safe experience for its membership; however, it is further understood that ice skating is inherently dangerous and neither Starlight nor its officers or board members assume any financial responsibility for any accidents that may occur.
I have read and understand the Safe Sport Statement and Member Code of Conduct.