USA Roller Sports 4730 South Street Lincoln, NE 68506 402.483.7551 phone 402.483.1465 fax 2013 CLUB CHARTER REGISTRATION AND VERIFICATION OF OFFICERS Important…Please be aware that individual memberships will not be processed for members affiliated with this club until charter is complete! PLEASE PRINT CLEARLY – USE FULL NAMES, NOT NICKNAMES Has this location ever had a chartered USARS club? ____Yes Has this location ever been a member of the RSA? ____Yes
____No ____No
Club Id #: RSA Id #:
Type of Club: Check only one subcategory under each sport. Additional subcategories must be chartered on a separate form. Speed $80 ___inline ___quad ___both
Hockey $80 Recreation $80 ___rink ___jam ___select ___fitness ___house (no charge) ___inline ___select ___house (no charge)
Aggressive $80 ___skateboard ___extreme inline
Roller Derby $80 Figure $80 ___flat or banked track women ___all types ___flat or banked track men ___flat or banked track junior ___flat or banked track co-ed Circle type of track or both (if applicable)
Club Name: Premises where club activities will take place: Facility Name: Address/City/State/Zip: Phone: ________________ Fax: ________________
Size of Skating Surface: ___ x ___feet. Type of Surface:
Club Mailing Address (only if different from address above): Club Contact: Address/City/State/Zip: Phone: ________________ Fax: ________________
Cell: ________________ Email:
Club Officers (officers must be at least two separate people and 2013 USARS members; if they are not 2013 members their individual registrations must be submitted with this charter application): Email Address:
President: Signature:
Check all that apply: _____Competitor this season
Secretary/Treasurer:
_____Non Competitive
_____USARS Coach
Email Address:
Signature: Check all that apply: _____Competitor this season
_____Non Competitive
Additional Club Officers authorized to sign transfer releases (MUST BE USARS MEMBERS). Print Name:
Email Address:
Signature:
Title:
_____USARS Coach
Print Name:
Email Address:
Signature:
Title:
Print Name:
Email Address:
Signature:
Title:
All officers and persons authorized to sign club releases must hold a current (2013) membership with USARS. A club charter and all associated memberships will not be sent until all officers and persons authorized to sign club releases have been registered with USARS. To be entitled to full voting privileges, a USARS club must have a minimum of five (5) active members, and no club may be registered without a minimum of two (2) officers: President and Secretary/Treasurer. Applicants will be notified if their application is incomplete. The incomplete application will be held for 60 days after which it will be returned and skaters so notified that they are free to re-affiliate with another club. AGREEMENT The undersigned representatives of the club organization hereby make application for Club Membership under sponsorship of USA Roller Sports (USARS) and do certify that all club members shall be individually bona fide members of USARS, and if accepted, agree to observe, uphold, and respect the By-Laws, Rules and Regulations of this Confederation as they affect amateur competitive roller sports. The undersigned club officers agree to indemnify and hold USARS harmless from any and all damages or liability which may be asserted against USARS as a result of the undersigned club officers’ failure to so observe and enforce said By-Laws, Rules and Regulations of this Confederation as they affect competitive roller sports, or as a result of the undersigned club officers’ negligence, or as a result of any other fault on the undersigned club officers’ behalf. The undersigned club officers further agree that they have no express or implied authority to bind, obligate or hold themselves out as agents of USARS. The undersigned club officers further agree that all sanction fees will be promptly turned over to USARS Headquarters according to the terms of the sanction. The undersigned club officers also agree to submit a copy of all club minutes and the Club Constitution to USARS Headquarters. A copy of any contracts and/or leases with facilities must be included with this application By signing below, the undersigned acknowledges that they have had an opportunity to review the insurance policy in place for all USARS members and clubs, understands the contents and limitations contained therein, and have had an opportunity to ask any questions regarding said insurance policy. PLEASE SIGN BELOW For Club: President: _______________________________
Secretary/Treasurer: ___________________________
Date: __________________________________
Date:
The undersigned facility owner/operator hereby agrees to allow the host club to use the facility as their chartered facility. For Facility: Print Owner/Operator Name: ________________
Owner/Operator Signature: _____________________
Date: __________________________________
Date: CREDIT CARD INFORMATION
Send completed application and check to: USA Roller Sports 4730 South Street Lincoln, NE 68506 Phone: 402.483.7551
CCV#:
Card Number: Expiration Date:
Billing Zip Code:
Name on Card:
Fax 402.483.1465 For Credit Card Payment Only
Signature: Total Amount To Charge:
Please make a photocopy of this completed form for your club’s future reference.
Importantâ¦Please be aware that individual memberships will not be processed for members affiliated with this club until charter is complete! ... ___select. Circle type of track or both (if applicable). ___house (no charge). Club Name: Premises where club activities will take place: Facility Name: Address/City/State/Zip: Phone: ...
Great Britain also known as Britain is a large island in the north Atlantic Ocean off the northwest coast of continental Europe With an area of 209 331Online PDF ...
in track and field at age 13, trying it during physical education class in school⦠Outside Interests: Works as a gym attendant at the Tournament Capital Centre in Kamloops⦠Studied kinesiology at the. University of Saskatchewan (2009-11), complet
New players will need to purchase jerseys. â« High School Girls Varsity ... Player's Email: ... List all other hockey teams you will play for during this season: ...
Run your laptop on 12VDC. â Page eight. -- .... 16-17 SARL Field Day HF contest 10:00-10:00. 16-17 LZ DX ... Using a .82 inch diameter Mylar diaphragm, the - 3dB points of the wide frequency range is set .... Notebooks this will be sufficient.
Dukes of hazzard theserie.80885151875. Machine gun kelly est 4 life.MedicalNutritionTherapy.Electro club house 2013.588215103883.Sexy patients pain.Indie playlistaugust. 2012.Encyclopedia of pharmaceutical pdf.Howto getawaywithmurder s02 x264 ettv.Ð
club 2013 2cd albumdance mp3 256kbpscbr. áÃoðÃâ¡Ã°ÃâÃÅ Ã1â4ÃÆ÷Ãâ¹Ãoð va top 50 club winter hits. mp3 2013 ÃâÃ3â4Ãâ¬Ãâ¬ÃμÃ1â2Ãâà ̧Ã1â2Ã3â4.
Reality Tour is a national project of CANDLE, Inc. All rights reserved. Page 1 of 1. RT Registration 2012 2013.pdf. RT Registration 2012 2013.pdf. Open. Extract.
Run your laptop on 12VDC .... trying to rein in the more irresponsible in the radio community and make sure that "hostile legislation" ... from M0MTJ website.
Aug 22, 2016 - Club Sports Registration/Insurance/Liability Waiver. In consideration for my ... Expiration Date: ____/____/______. Emergency Contact: Name: ...
Infrastructure, roads,. and bridges 80% 20%. 3. Whoops! There was a problem loading this page. Retrying... 2017-2018 Kids Club Registration Form copy.pdf. 2017-2018 Kids Club Registration Form copy.pdf. Open. Extract. Open with. Sign In. Main menu. D
Page 1 of 1. Name of Child: Phone: Teacher: Grade: Email: (Club confirmations will be e-mailed by Sunday, March 4). I would like to participate in: (please number your preferences or leave blank if not. interested in a club). Classic Movie Club: Mond
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Oshkosh Flyers ...
I acknowledge that I have read and understood, provided the required information, ... minutes that you are late. ... If you know that you are going to be late, ... the months of December and March to accommodate for Christmas break and Spring.
Whoops! There was a problem loading this page. Citizen's Charter Year 2013-2014.pdf. Citizen's Charter Year 2013-2014.pdf. Open. Extract. Open with. Sign In.
commitment to making progress towards LGBT equality. LGBT Youth ... networking events with other Charter clients. ... LGBT Charter of Rights - 2013.pdf. LGBT ...
Please ensure that copies of all registration forms accompany this entry form. Ensure that your Amateur Status form / Novice Status form is on file with NAPHA prior to the show, if applicable. Mail completed package to Show Secretary per show premium
Our participation proved necessary and timely. A Penny for Your Thoughts by Alan Baker. Page 3 of 4. Fremont Stamp Club-August 2013-1.pdf. Fremont Stamp ...
email to: [email protected]. 2013 Officers. Ken Goss President. Dave Epps Vice President. Theresa Goss Secretary. Bill Beeson Treasurer. Ken Goss Editor.
Booster Club Handbook 2012 2013-Final.pdf. Booster Club Handbook 2012 2013-Final.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying Booster ...