Laurel Ridge Skating Club Test Application - Dance Test Date : ____________ Time : ________________ Location : _____________ Skater’s name :
USFSA# :
Address : Phone : email :
Written permission from an officer of Home Club required for non-LRSC member
Home Club : Professional’s Signature :
Phone :
Please circle all tests that you would like to take. Compulsory Dance (Circle Appropriate Test) Standard, Adult, Masters, Solo Preliminary: DW, CT, RB Pre Bronze: SD, CC, FIT Bronze: HH, WIW, TF Pre Silver: 14S, EW, FT Silver: AW, T, RF Pre Gold: K, BL, PD, SW Gold: VW, WW, QS, AT International: AUS, CON, GW, MB, RW, SAM, TR, YP
$25.00 each $25.00 each $30.00 each $30.00 each $35.00 each $35.00 each $45.00 each $45.00 each
Free Dance (Circle Appropriate Test) Standard, Adult, Masters Juvenile Intermediate Novice Junior Senior
$35.00 each $40.00 each $50.00 each $60.00 each $65.00 each
Make your checks payable to : Total for all tests Laurel Ridge Skating Club Mail to : Test Chair Laurel Ridge Skating Club PO Box 1133 Danbury, CT 06813
Non-member fee Late application fee
$30.00 * $20.00
Grand total: *Note : Late application fee required after the due date.
Due Date : _________________