MEMBERSHIP GUIDELINES 2017 - 2018

The Duluth FSC uses Paypal for Online Membership Registrations

Skater's Full Name *

USFSA Number: (Optional; DFSC can access database)

Address *

City, State, Zip *

Date of Birth *

Email Address *

Highest MIF Test Passed
(Enter BEG if skater has not tested) *

Highest Freestyle Test Passed
(Enter BEG if skater has not tested) *

Coach *

Parent(s)/Guardian(s) *

Home Phone Number *

Cell Phone Number *

Emergency Contact (Other than Parent/Guardian) *

Emergency Contact Phone Number *

Emergency Medical Facility *

Physician *

Insurance Provider *

Home Club (if other than Duluth)

I agree

Check this box to indicate you have read the SafeSport statement here and agree to abide by its rules and guidelines set forth as part of DFSC membership renewal.

*

Membership Types

The following DFSC types of membership*/fees are available for those joining between July 1, 2017 and June 30, 2018. Home Club Individual or Family Memberships must fulfill volunteer requirements (shown below), contract at least 1 freestyle/week each month**, and either monitor 2 sessions or pay $20/month from September-May.

A PDF of the different membership types and guidleines is available here.

Select Only One

Home Club Individual

$170 July 1, 2017 to June 30, 2018

$115 Feb 1, 2018 to June 30, 2018

$95 July 1, 2017 to June 30, 2018—Only offered to FIRST TIME DFSC MEMBERS who previously participated in DFSC Learn to Skate and/or Academy

Home Club Family - Family membership consists of one parent/legal guardian and up to three children less than 19 years old residing at the same address. Add $10 for each member over and above four.

$195 July 1, 2017 to June 30, 2018

$135 Feb 1, 2018 to June 30, 2018

Skater 2 Full Name

USFSA #

Date of Birth

Coach

Highest MIF

Highest Free

Skater 3 Full Name

USFSA #

Date of Birth

Coach

Highest MIF

Highest Free

Skater 4 Full Name

USFSA #

Date of Birth

Coach

Highest MIF

Highest Free

Additional Skater 1

$10

Addt'l Skater Full Name

USFSA #

Date of Birth

Coach

Highest MIF

Highest Free

Additional Skater 2

$10

Addt'l Skater Full Name

USFSA #

Date of Birth

Coach

Highest MIF

Highest Free

Home Club NON-CONTRACTING

$120

Home Club

Associate Individual*

$125 July 1, 2016 to June 30, 2017

$100 Feb 1, 2017 to June 30, 2017

Associate Family* See family definition above. Add $10 for each member over and above four. Make your selection and then complete the skater information in the Home Club family member section above.

$160 July 1, 2016 to June 30, 2017

$125 Feb 1, 2017 to June 30, 2017

$10 Additional Associate Family Member 1

$10 Additional Associate Family Member 2

Home Club

Collegiate** Individual must be a student at an accredited secondary or post-secondary institution and provide proof of enrollment at time of egistration

$225 Membership valid for 4 years from date of registration.

* Associate member must be home club member of another USFSA sanctioned skating club or individual member of USFSA.

** Collegiate member may only contract ice on weekends and during summer (Jun/Jul/Aug). Monitor duties apply excluding summer months.

Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement Consent for Medical Attention or Treatment (“Agreement”)

I agree

Check this box to indicate that you agree with the Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement; and Consent for Medical Attention or Treatment (Agreement). The "Agreement" is available to read here. *

Website Permissions

I hereby authorize the Duluth Figure Skating Club (DFSC) to display skating related photographs of the skater named above and to provide skating related information about the skater named above on the DFSC website.

Check this box to indicate that your consent of the Website Permissions *

I agree

I disagree

Payment Information

The Duluth Figure Skating Club uses PayPal for processing online payments. We strongly encourage online payment as it helps us maintain our costs.

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