Midland Speed Skating Club
2015 - 2016 Registration Form
Primary Contact
Street
City, Zip
Home Phone
Cell Phone
email address
Name and birth date
Learn to Skate
Group 1
Group 2
Skater 1
Skater 2
Skater 3
Skater 4
Skater 5
2014-2015 Season
Required Fees
Number of
Skaters
Rate per
month
$35.00
$50.00
$85.00
subtotal
Amount
Due
Number of learn to skate skaters
X
=
Number of beginner Skaters
X
=
Number of Int/Rec/Competitive
X
=
FAMILY CAP
Skating Fees Due, enter LOWER of Skating fee Subtotal or Family Cap
MSSC Club Dues
X
$10.00
FAMILY CAP
Club Dues, Enter Lowest Amount (Individual rate or Family Cap)
=
$25.00
Michigan Speedskating Assoc
Annual Dues
MSA Dues (No family rate enter subtotal)
X
$10.00
=
Optional Fees
Skate Rentals (Season)
Skin Suit rental (season)
FUNDRAISING BUYOUT
X
X
$60.00
$15.00
$200.00
=
=
=
TOTAL DUE AT REGISTRATION
Notes:
Midland Speed Skating Club (MSSC) and Michigan Speedskating Association (MSA) dues are paid once per season and
are not prorated. Non skating MSSC Memberships are encouraged.
Learn to Skate = up to Badge 2
Group1 (Beginner) = Badges 3 & 4; Must Skate in Group 1
Group 2 (Intermediate) = Badges 5+; Must Skate in Group 2
Recreational = Adult skaters that do not compete; Must skate in group 2
Competitive = Badges 7+ or with Coach’s permission; Must skate in group 2