ST. LOUIS METROPOLITAN SPEED SKATING CLUB, INC.
MEMBERSHIP APPLICATION
2004-2005
(Please fill out for all members of family)
NAME:
_______________________________________________________________
Last First Father (First) Mother (First)
PHONE: _________________________CELL PHONE: ________________________
E-MAIL ADDRESS: ____________________________________________________
|
SKATER’S NAME |
AGE |
BIRTHDATE |
DIVISION (see below) |
CLUB DUES (see below) |
|
|
|
|
|
$ |
|
|
|
|
|
$ |
|
|
|
|
|
$ |
|
Activity feE
($150)* |
|
|
|
$ |
|
TOTAL AMOUNT DUE |
|
|
|
$ |
*
Activity fee of $150 is due if you didn’t participate in the 2004 Fair St.
Louis fundraiser.
TOTAL
AMOUNT DUE PAYABLE WITH THIS APPLICATION.
PLEASE
MAKE CHECK PAYABLE TO: METROS SPEEDSKATING CLUB
|
Division (age as of July 1) |
|
|
Tiny
Tot |
5
and under |
|
Pee
Wee |
6-7 |
|
Pony |
8-9 |
|
Midget |
10-11 |
|
Juvenile |
12-13 |
|
Junior |
14-15 |
|
Intermediate |
16-17 |
|
Senior |
18-29 |
|
Master |
30
and under |
|
CLUB DUES |
|
|
Skating Member – all rinks |
$600 |
|
Skating Member – one rink (Webster, Summit, Ice Zone) |
$250 |
|
Skating Member – one rink (North County) |
$100 |
In
consideration of the St. Louis Metropolitan Speed Skating Club, Inc. (“Metros”)
accepting this membership(s), I (we), the undersigned, do hereby for myself, my
heirs, administrators, executors and assigns, waive and release any and all
rights and claims for damages I may have against Metros, it’s officers and
member clubs and/or the owners of any property which may be the site of any
meets, practices, contests or other club events, agents, representatives,
members, successors and/or assigns, for any and all damages which may be
sustained or suffered by me in connection with and/or arising out of my
traveling to, participating in, and returning from said contests or
events.
*(Parent
or Guardian must sign if applicant is under 18 years of age)
Please
return to: Harlan Kwiatek
Metros
Speedskating Club
409 Hibler Woods
Ct.
St. Louis,
MO 63141
(314) 434-7073