CENTRAL CALIFORNIA INTERCLUB ASSOCIATION
1999 NOVICE / ADVANCED COMPETITION
June 18, 19 & 20, 1999

Hosted by Santa Rosa Figure Skating Club                    Sanctioned by USFSA

ENTRY FORM

Name_____________________________________________________ USFSA#____________________

Street___________________________________________ City________________State____Zip_______

Phone ( )____________________________ Birthdate________________Age_______Sex M_____F_____

Partners Name__________________________________________ Phone ( ) _______________________

Coach(es)_____________________________________________ Phone ( )_________________________

Highest Test (s) Passed ___________________________________________________________________

Home Club_________________________________________

Highest 1998 CCIA Placement and and event _________________________________________________

PLEASE PROVIDE FULL TITLE OF EVENT (S) ENTERED

EVENT ENTERED _____________________________________________________________________________

EVENT ENTERED _____________________________________________________________________________

EVENT ENTERED _____________________________________________________________________________

EVENT ENTERED _____________________________________________________________________________

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ENTRY FEES

       
$ 50.00     (First singles event ( Moves in the Field, Freeskating, Short Program,
    __________
       Artistic, Basic Moves / Basic Freeskating and Solo Dance)    
$ 25.00     Each Additional singles event    __________
$ 60.00     Pairs/Dance or Shadow Dance (per couple)     __________
$ 10.00     Precision Team, First event (per team member)     __________
$ 5.00         per team member for each additional Precision Team event     __________
    Total     __________

Make checks payable to “1999 CCIA - SRFSC”
Must be mailed with Entry Form, Club Certification and Medical Release Form
Prior to DEADLINE OF MAY 7, 2026 to:

SRFSC - CCIA 1999
Attn: Maureen Feldman
1667 West Steele Lane
Santa Rosa, Ca. 95403


For more information - voicemail: (707) 546-7147 Ext. 867 or e-mail: [email protected]

Updated 2026/04/20 kah



SANTA ROSA FIGURE SKATING CLUB, Inc.
1667 West Steele Lane,
Santa Rosa, CA 95403
Phone: (707)546-7147 Ext. 867
(www.srfsc.org)



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