A separate form must be completed for each family member. If the UDFSC is your "Home Club," your Membership includes membership in the USFSA. If the UDFSC is not your "Home Club," please be sure that your Home Club pays your USFSA membership dues.

Please print and mail this form and your check to the address provided at the end.

Check one:	new application, renewal Renewals are subject to a $10 late fee if received after 7/31/03
Name:
Local Address:
City:
State:	Zip Code:
Local Phone with Area Code:
Permanent Address:
City:
State:	Zip Code:
Permanent Phone with Area Code:
Mail newsletters to:	local address, permanent address (check one)
E-mail:
Date of Birth:	Age: (see next section)
Sex:	male, female
U.S. Citizen:	yes, no
Present USFSA #:	(if you do not have a USFSA #, leave blank)
Present Home Club:
Will the UDFSC be your home club?	yes, no
Are you a coach?	yes, no

Note: If you are changing your Home Club at the beginning of the membership year, you DO NOT need to submit a Change of Home Club form with your membership application. If you are changing Home Clubs in the middle of the year, you must get a Change of Home Club form from your previous Home Club and submit the completed form with this application.

Check all items below that apply.

List USFSA levels (freestyle, figures, dance, pairs) as of 07/01/03.

All applicants must complete the section above.
The section below must be completed by all Applicants under 18 on 7/01/03.

In recognition of the privilege of using the University of Delaware Ice Arenas as a Member of the University of Delaware Figure Skating Club, I (we) accept full responsibility for any accident which may occur in connection with such use and do hereby covenant with the University of Delaware and the University of Delaware Figure Skating Club that I (we) will never sue or bring any legal action against them or their successors or against any of their agents or employees nor will I (we) bring such action against the UDFSC Board of Directors and I (we) agree to indemnify and save harmless the University of Delaware, its agents and employees and the UDFSC and its Board of Directors from any and all claims which may arise in connection with my (our) use of the said Ice Arenas.

Signature: Date:

B: EMERGENCY TREATMENT RELEASE: UNIVERSITY OF DELAWARE POLICY:
This section must be completed by a parent or guardian if you are under the age of 18. Application will be returned if not completed.

I, hereby authorize any physician and/or member of the Medical Staff of any hospital or emergency treatment center to render medical treatments which, in his/her judgment may be deemed necessary in the care of:

Child's Name:

Child's Birthdate: Child's Age:

Child's Allergies:

Medicines Child takes regularly:

Past Medical History:

Parent/Guardian Signature:
Date:
Parent Name:
Parent Address:
Parent Address:
Emergency Phone:

2003-04 Membership Dues (NO CASH WILL BE ACCEPTED) $65 First family member $35 New members after 1/1/04 $30 Subsequent immediate family member $45 Associate member (non-home Ccub individual) $10 Late fee for renewals received after 7/31/03 TOTAL (Check or money order attached. NO CASH.)

Return, with check, via U.S. Mail to: UDFSC Rust Ice Arena South College Avenue Newark, DE 19716 Or, use Club Lockbox located in office hallway of the Rust Ice Arena. Check or money order payable to UDFSC must be stapled to application. One check may cover several family members if all applications are stapled together.