Sydney figure skating club

Post to SFSC, PO BOX 332, CROYDON PARK, 2133, NSW

Or deliver to SFSC Mailbox at Canterbury Ice Rink

SYDNEY FIGURE SKATING CLUB

www.sydney-fsc.com
2011 HOLLINS TROPHY, June 10^th to 13th

ENTRY FORM
Division: ………………………………………………………… Email Address…………………………………………………………....
Full Name: ………………………………………..………………………………………........... Phone: ………................................
Address: …………………………………………………………………. ………………………………………..…. Postcode: …………..
Date of Birth: …...…/…...…/...…... Age…..…… Proof of Age No. : ………………… ( Male or Female )
Test Passed: Freeskating……………………………………………………..……………………………
Pair…………………………………………………….Dance…………………….…………..............................................
Association…….………. Member No. : ……….………………. Club………………. Member No.: ……………

Coaches: …………………………………………………………………………………………………………………………………………..
MUSIC DETAILS
SHORT PROGRAM Overall Duration: ………….mins …………..secs
(1^st cut) Disc/Tape No. ………………………….…… Title ………………..…………………………………………….. Duration……………..

Composer: …………………………………………………………………. Orchestra …………………………………………………………….
(2^nd cut) Disc/Tape No. ……………………………… Title ………………………………………………………………. Duration …………….
Composer: …………………………….…………………………………… Orchestra ………………………..…………………………………..
(3rd cut) Disc/Tape No. ……………………………… Title …………..…………………………………………………… Duration …………….

Composer: ……………………………….………………………………… Orchestra ……………………………..……………………………..

FREE SKATING PROGRAM Overall Duration: ………….mins …………..secs
(1^st cut) Disc/Tape No. ………………………….…… Title ………………..…………………………………………….. Duration……………..

Composer: …………………………………………………………………. Orchestra …………………………………………………………….
(2^nd cut) Disc/Tape No. ……………………………… Title ………………………………………………………………. Duration …………….
Composer: …………………………….…………………………………… Orchestra ………………………..…………………………………..
(3rd cut) Disc/Tape No. ……………………………… Title …………..…………………………………………………… Duration …………….

Composer: ……………………………….………………………………… Orchestra ……………………………..……………………………..

AGREEMENT

I/We confirm that I/we meet the test, age and other requirements of eligibility in the published rules for this competition.

I/We agree to assume all risk of injury or loss for myself/ourselves or, if a parent/guardian on behalf of my child/ward and do hereby release and in all respects discharge and agree to hold harmless the Sydney Figure Skating Club, its officers and volunteers from any claim arising from loss or injury associated with participating in this event.
Signature: ………………………………….. ………. Date: ………………….

(Parent’s/Guardian’s Signature for member under 16 years of age)

NO CASH- PLEASE MAKE CHEQUES OR MONEY ORDERS PAYABLE TO: THE SYDNEY FIGURE SKATING CLUB

Ref: SFSC 1-3-1