Metros Speedskating Club

Membership Form

ST.  LOUIS METROPOLITAN SPEED SKATING CLUB, INC.
MEMBERSHIP FORM
GENERAL RELEASE AND WAIVER
2007-2008
(Please fill out for all members of family)

NAME:
________________________________________________________
  Last                        First        Father (First)         Mother (First)          
ADDRESS:
_________________________________________________________

CITY: _____________________STATE: ____ZIP: ________________
PHONE: _________________________
CELL PHONE: ________________________

E-MAIL ADDRESS:
____________________________________________________

SKATER’S NAME        AGE        DOB   DIV. (see below)        DUES/FEES

1._______________  ____  ______  ____________    $__________   

2._______________  ____  ______  ____________    $__________   

3. _______________  ____  ______  ____________   $__________   

4._______________  ____  ______  ____________    $__________   
  ACTIVITY FEE - $150*                                               $ _________     
TOTAL AMOUNT DUE                                                    $_________     
                   
*  -  Activity fee of $150 is due if you didn’t participate in the 2007 Live
on the Levee fundraiser.   

TOTAL AMOUNT DUE PAYABLE WITH THIS APPLICATION.
PLEASE MAKE CHECK PAYABLE TO: METROS SPEEDSKATING CLUB

DUES/FEES
Skating Member – all rinks -  $700*
Skating Member – one rink (Webster, Ice Zone, Queeny) -   $350*
Non-member – per session fee - $15

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 over

In consideration of the St. Louis Metropolitan Speed Skating Club, Inc.
(“Metros”) accepting this application, 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.  

Signature:
_______________________________________________________
*(Parent or Guardian must sign if applicant is under 18 years of age)
Date: ___________


Please return to:                 
                              Metros Speedskating Club
                              409 Hibler Woods Ct.
                              St. Louis, MO  63141
                                      (314) 434-7073