Testing Application

Thursday December 3rd, 2009, 10:00 a.m. - 4:00 p.m.
Location To Be Announced

Registrations must be received by November 21st

This completed application and the permission to test from home club test chair must be received by November 21st 2009. Priority will be given to the higher level tests, in the event of more applications than time allows. A test schedule will be mailed to out of town skaters one week prior to the test date. There will be no refunds of test fees for any reason including medical after the closing date or if the skater is unable to take a freestyle test because they didn’t pass a MIF test.

Skaters Name

USFS Number

Address

City / State

Phone Number

Home Club

Parent's Email

Coach

Club Officer Email

Indicate Test Level Desired: (Please check the box for the appropriate test level and fee).

MOVES IN THE FIELD

Moves In The Field
DFSC MEMBER FEE

Moves In The Field
NON-MEMBER FEE

FREESTYLE

Freestyle
DFSC MEMBER FEE

Freestyle
NON-MEMBER FEE

ADULT MOVES

Adult Moves
DFSC MEMBER FEE

Pre-Bronze $25.00

Bronze $25.00

Silver $30.00

Gold $30.00

Adult Moves
NON-MEMBER FEE

Pre-Bronze $50.00

Bronze $50.00

Silver $55.00

Gold $55.00

ADULT FREESTYLE

Adult Freestyle
DFSC MEMBER FEE

Pre-Bronze $25.00

Bronze $25.00

Silver $30.00

Gold $30.00

Adult Freestyle
NON-MEMBER FEE

Pre-Bronze $50.00

Bronze $50.00

Silver $55.00

Gold $55.00

REFRESHMENT FEE

*Each skater pays $5 fee for Judge’s refreshments.

PLEASE BE AT THE RINK AND READY AT LEAST 45 MINUTES BEFORE YOUR SCHEDULED TEST TIME.

VERIFICATION

I have verified my test levels with my coach

Yes

PAY BY CHECK

To pay by check please complete and Submit this form and send your payment to:

DFSC c/o Cindy Sund clsund@aol.com
4386 Normanna Road Duluth, MN

Registrations must be received by November 21st, 2009.

Indicates Response Required