Missoula Figure Skating Club United States Figure Skating Test Session Thursday, March 19, 2015 1:00 pm (estimate) Glacier Ice Rink, Missoula County Fairgrounds Test Application Deadline is February 26th Application Form Last Name ____________________________________ First Name ___________________________________ USFS# _______________________________ Home Club ___________________________________________ Address _______________________________________________________ City ________________________ State _______ Zip ______________ Phone(s) ____________________________________________________ Email_______________________________________Coach’s Email___________________________________ Dance/Pair Partner Name __________________________________ USFS#_____________________________ Tests Offered - Please Circle the Tests you want to take: Moves in the Field Rate Free Skate/Pairs Rate Free Dance* Dance * Rate/Dance Pre-Preliminary $35 Pre-Preliminary $25 Juvenile $35 Preliminary: DW CT RB $25 $30 Intermediate $40 Pre-Bronze: SD CC FIT $30 Preliminary $40 Preliminary $45 Bronze: HH WW TF $35 $50 Pre-Juvenile $35 Novice Pre-Juvenile $35 Junior $55 Pre-Silver: EW FT 14S $40 Juvenile $55 Juvenile $60 Silver: AW RF T $45 $60 Intermediate $40 Senior Intermediate $30 Pre-Gold: SW PD KI BL $50 Novice $65 Novice $45 Ad/Mas Pre-Bronze $70 Junior $55 Ad/Mas Bronze $35 Gold: VW WW QS AT $55 Junior $75 Senior $65 Ad/Mas Silver $35 Int'l: Aus, Con, GW, MB, RW, R, Sam, TR, YP, FS $60 Senior $40 Adult Pre-Bronze $40 Adult Pre-Bronze $30 Ad/Mas Gold Please circle type of test: Adult Bronze $45 Adult Bronze $35 Please circle type of test: Standard or Solo Standard Adult Silver $50 Adult Silver $35 Partnered Adult or Solo Adult Adult Gold $60 Adult Gold $40 Solo Masters or Solo Masters Int. Suppl. $60 NOTE: USFS Test Registration Fee is included Sen. Suppl. $75 *Pairs, Free Dance & Dance Fees are per skater testing in the above prices. Payment Summary Test Type Total Fees Due (add totals from above for each test category) Moves in the Field Free Skate/Pairs Free Dance/Dance Practice Ice Amt Due (see attached form) → If you are a Non-MFSC Member or Associate Member – Add $15 → Hospitality Fee (required) $15 Return Form & Payment By: Feb 26th All Test Fees Must Accompany Application Make Checks Payable to: Missoula FSC No Refunds Send To: Sandi Janusch MFSC Test Chair 2648 Loraine Court Missoula MT 59803 (406) 406-830-0260 or [email protected] Mailed after 2/26 – Add $20 late fee → TOTAL AMOUNT DUE Skater's Signature ___________________________ Parent's Signature ______________________________ Coach's Signature _____________________________________ (for skaters under 18 years old) Test Chair Certification (if skater is a member of a different Club): The above applicant is a member in good standing with USFS. Test Chair Signature _________________________________________* *Your Club's Test Chair must send a letter or email of permission to the MFSC Test Chair if they do not sign this form. Send emails to Sandi Janusch at [email protected] Missoula Figure Skating Club Test Session Practice Ice Request Form Thursday, March 19, 2015 Practice Ice Request Deadline is Feb 26th Submit this form with your TEST form and send one check for test and practice ice to MFSC Skater Name:______________________________________________________ Address:__________________________________________________________ Phone(s):_________________________________________________________ Skater Email:________________________________________________________ Coach Email: ______________________________________________________ Club:___________________________ USFS#____________________________ NOTE: The Test & Practice Ice schedule will be emailed to you and your coach. Please include email addresses above and on your test form. Skating Level you are Testing: Moves_______________FS/Pairs____________Dance/Free Dance_____________ Register for 30 minute sessions at $15 per session in advance ($20 walk on, if space permits). There will be no refunds for practice ice unless the sessions requested are not available. Sessions are scheduled “first come, first served”. Check (√) the Sessions you want: Moves Test Practice Ice _____ = $15.00 Free Skate/Pairs Test Practice Ice _____ = $15.00 Dance Test Practice Ice _____ = $15.00 Total Amount Due $_________ Please transfer this amount to your Test Form and write one check to Missoula FSC. Return Test & Practice Ice Forms & Payment to MFSC by: Feb 26th All Test and Practice Ice Fees (one check) must accompany your Test and Practice Ice Forms Make Checks Payable to: Missoula Figure Skating Club No Refunds Send To: Sandi Janusch MFSC Test Chair 2648 Loraine Court Missoula MT 59803 (406) 406-830-0260 or [email protected]