Test and Practice Ice Form June 2015

Missoula Figure Skating Club
United States Figure Skating Test Session
Saturday, June 20, 2015 8:00 am (estimate)
Glacier Ice Rink, Missoula County Fairgrounds
Test Application
Deadline is
June 4th
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 *
$35 Pre-Preliminary
$25 Juvenile
$35 Preliminary: DW CT RB
$30 Intermediate
$40 Pre-Bronze: SD CC FIT
$40 Preliminary
$45 Bronze: HH WW TF
$50 Pre-Juvenile
$35 Novice
$35 Junior
$55 Pre-Silver: EW FT 14S
$55 Juvenile
$60 Silver: AW RF T
$60 Intermediate
$40 Senior
$30 Pre-Gold: SW PD KI BL
$65 Novice
$45 Ad/Mas Pre-Bronze
$70 Junior
$55 Ad/Mas Bronze
$35 Gold: VW WW QS AT
$75 Senior
$65 Ad/Mas Silver
$35 Int'l: Aus, Con, GW, MB, RW, R, Sam, TR, YP, FS
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
Adult or Solo Adult
Adult Gold
$60 Adult Gold
Masters or Solo Masters
Int. Suppl.
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)
Return Form & Payment By: June 4th
All Test Fees Must Accompany Application
Make Checks Payable to:
Missoula FSC
No Refunds
Send To: Shari Riley
MFSC Test Chair
2783 Larch Camp Rd
Missoula MT 59803
(406) 207-8023 or [email protected]
Mailed after 6/4 – Add $20 late fee →
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 Shari Riley at [email protected]
Missoula Figure Skating Club
Test Session
Practice Ice Request Form
Saturday, June 20 2015
Practice Ice
Deadline is
June 4th
Submit this form
with your TEST
form and send
one check for
test and practice
ice to MFSC
Skater Name:______________________________________________________
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: June 4th
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: Shari Riley
MFSC Test Chair
2783 Larch Camp Rd
Missoula MT 59803
(406) 207-8023 or [email protected]