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Contents : The Skating Club of Wilmington 1301 Carruthers Lane Wilmington DE 19803 302-656-5005 APPLICATION FOR REPRESENTATIONAL MEMBERSHIP FOR POWER PLAY SKATERS Name (Dr.)(Mrs.)(Mr.)(Ms.) . Legal First Name (and spouse) Middle Initial Last Name Home Address: Street City State Zip Member: Home Phone: Work: Mobile: Email: *By providing your email address you agree that SCW may provide you by electronic mail notices required by law and by SCW's governing documents. Other family members who are applying for representational membership and birth dates: Name: Birth date: (1) (1) (2) (2) (3) (3) Highest US Figure Skating Tests passed: Highest ISI tests passed: FEES: The Representational Membership $90.00 and includes USFS membership for the first skating member of the family. The representational membership allows you to represent The Skating Club of Wilmington at US Figure Skating events competitions and test sessions. It includes the dues for US Figure Skating for the first skater in the family. You may also purchase ticket books at the member price. US Figure Skating dues for the first skating family member are included in Representational membership fee. Additional skaters in the same family are $20.00 each. If you are already an Individual Member of USFS for the current skating year we can transfer your membership to SCW and your Representation Membership fee is $40. TOTAL DUES AMOUNT FROM NEXT PAGE (Please make checks payable to SCW) I (we) hereby apply for membership in SCW and have included the $90.00 representational membership annual dues plus (if applicable) an additional $20 for additional skating members. I (we) agree to comply with the rules and by-laws of the Club (See SCW Handbook and Supplement) I (we) understand that ice skating is a dangerous sport and hereby waive any claims for damages sustained in the course of ice skating at the Skating Club of Wilmington.) I (We) understand that photos and videos may be taken of skaters and others at SCW during regular and special skating activities. These images may be used for publicity for SCW which may include SCW s web site and print and internet publications and media. In some instances skaters are identified. I will notify SCW if I have any objection to having myself or a family member photographed videotaped or identified. Adult Signature: Amount Enclosed: Date: FEE WORKSHEET SCW REPRESENTATIONAL MEMBERSHP FOR POWER PLAY Name For New U.S. Figure Skating Members SCW Base Dues U.S. Figure Skating Dues - first family member $40.00 50.00 Name of Skater U. S. Figure Skating Dues additional family members 20.00 each Name of Skater Name of Skater Name of Skater TOTAL For current year U.S. Figure Skating Individual Members TOTAL SCW Base Dues $40.00 If you are already an Individual Member of U.S. Figure Skating please enclose a copy of each skater s membership card. Payment of USFS dues not required again until next year. Name of Skater Membership Number Name of Skater Membership Number Name of Skater Membership Number Name of Skater Membership Number Please make checks out to SCW. Thank you!

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