REDWOOD EMPIRE CRYSTALLINE CLASSIC
A SHOWCASE COMPETITION
SANCTIONED BY THE USFSA

REDWOOD EMPIRE ICE ARENA
1667 W. STEELE LANE
SANTA ROSA,CA 95403
707-546-7147 EXT.867


SPECIAL NEEDS EVENT ENTRY APPLICATION
ONLY


NAME_____________________________________BIRTHDATE_______________AGE:______

ADDRESS:________________________________________________M:________F:_______

_________________________________________________________________________

PHONE NO:

(_____)__________________HOMECLUB:_________________________USFSA#_________

PROFESSIONAL:_______________________________PHONE NO(_____)_________________



TELL US ABOUT YOUR PROGRAM:

LENGTH:______________________________

DO YOU HAVE MUSIC:______________________

DO YOU HAVE YOUR PRO ON THE ICE WITH YOU:________________________________________


CHECK LIST:

1.  COMPLETE CLUB CERTIFICATION.
2.  COMPLETE ASSUMPTION OF WAIVER.
3.  ENCLOSE ENTRY FEE.

THE ENTRY FEE FOR THIS EVENT IS ONLY $15.00.

ENTRIES MUST BE POSTMARKED BY FEBRUARY 27, 1999.

PAGE 10

Official Entry Form
1999 Crystalline Classic Competition

Name:_____________________________________________ (Please type or print legibly.)


Club Certification

IMPORTANT!!   The Club Certification and Parental Authorization MUST be signed or your entry will be returned !!

Club Certification  I hereby approve the entry of the above named entrant and certify that to the best of my knowledge:
1.  Entrant is a member in good standing of the Home Club listed.
2.  Entrant is eligible to enter the specified events.
3.  Entrant is an eligible person as defined by the rules of the USFSA.
4.  Entrant (if under 18 years of age) is complying with standard education policy.

  _________________________________________________            ___________________________________  
   Print name and title of club Official                                                      Signature of Club Official / Date

Assumption of Risk and Waiver of Liability:   I have read and agree to abide by the rules of this competition. I am aware that ice skating is a dangerous sport and at the competitor's sole risk and I agree to hold harmless Redwood Empire Ice Operations Inc., The Santa Rosa Figure Skating Club and The United States Figure Skating Association, and/or directors, officers, agents and employees from any and all loss, damage, and / or injury, whatsoever kind or nature, that may be sustained by the entrant in any manner while participating in any event of this competition.
The Chief Referee of the competition shall have the right to determine the fitness of any entrant to skate in the competition in accordance with the current USFSA rulebook.

  _______________________________________________________                _________________  
   Print name and provide signature of parent or guardian if competitor under 18 years.           Date

  ______________________________________________          ___________________________________  
   Signature of competitor is over the age of 18.                                     Date

Entry Fees:
   
   
   
   
First singles event:
      
   
$60      
 ______
For each additional event:
      
   
$30      
 ______
Pairs (per couple):
      
   
$65      
 ______
Groups:
      
   
$60 + $5 Per person      
 ______
Special Needs:
      
   
$15      
 ______
Make checks payable to:
      
   
TOTAL      
 ______
"Santa Rosa Figure Skating Club"
      
   
   
   
($50 charge for returned checks)
      
   
   
   
Mail To: Carol Wykoff, c/o S.R.F.S.C.
      
Entries must be postmarked by midnight,
   1667 West Steele Lane, Santa Rosa, CA 95403
      
February 27th, 1999.
   Santa Rosa, CA 95403
      
Entries after this date are subject to $25.00 late fee.
FOR SANTA ROSA FSC Use Only:
Date received:_____________ Paid by check/Money order #__________ Total amt. $_________


Page 11.
webpage updated 99/02/01 kh

This is the 1999 Crystalline Special Needs Application, page 8-9.
RETURN TO 1999 Crystalline Home page.


Return to Competitions Index
Go to Santa Rosa Figure Skating Club Home Page