Queen City Figure Skating Club
Presents
Grassroots to Champions Figure Skating Seminar
Saturday April 26, 2014
Northland Ice Center
10400 Reading Road
Cincinnati, Ohio 45241
Skater/Coach Name:
Address, City, State Zip:
Phone Number:
Emergency Number:
Email:
Home Club:
Skater Level:
Please Check One.
Working On Jumps
Working on Axel
Solid Axel, working on doubles
Double & above
Queen City Figure Skating Club Member Early Bird Registration by 3/1/2014
Queen City FSC Member Tuition Early Bird registration before 3/1/2014
Skater tuition for Grassroots to Champion Seminar before 3/15/2014 ***
Skater tuition for Grassroots to Champions Seminar after
3/15/2014
(*** Payment & Registration must be received or postmarked by deadline date)
Total Payment
$155.00
$165.00
$185.00
$______
Make checks payable to Queen City Figure Skating Club
Mail to: Margaret Ivnik, 304 Leather Leaf Lane, Lebanon, OH 45036
Please pack snacks and water for your skater as we cannot guarantee that the concession stand will be open.
Please email g2C@queencityfsc.com for questions or more information.
The undersigned approves this registration and agrees to hold harmless Grassroots to Champions, US Figure
Skating, Ice Skating Institute, Queen City Figure Skating Club and Northland Ice Center from any and all
loss,damage and/or injury sustained in any manner while participating in any activities of this seminar.
Coach Signature:___________________________________________________Date:_____________________
Skater Signature:___________________________________________________Date:_____________________
Parent/Guardian Signature:__________________________________________Date:______________________