July 1, 2008 through June 30, 2009
USFS, ISI, CFSA, USA Hockey Number:
USFS, ISI, CFSA, USA Hockey Home Club:
Last Name:
First Name:
Middle Initial:
Family Membership:
First Family Member
Subsequent Family Member
Address:
City: State: Zip Code:
Country:
Home Phone:
Work Phone:
Cell Phone:
Fax Number:
Primary E-Mail:
Secondary E-Mail:
Birthdate:
Gender:
U.S. Citizen: Yes No
Year of High School Graduation:
Parent(s) Name(s):
Membership Type Applying for: Full ($50.00) Associate ($30.00)
WESA Member Since:
Do you want to be listed in the WESA
Directory/Website?
Yes No
Consent to allow photographs of my skater
or myself to appear on our website, printed,
marketing or promotional materials.
Yes No
Skater's Coach(s)
Primary Interests:
Competitive Skater Level:
Recreational Skater
Adult Skater Hockey
Synchro Skater Speed Skater
USFS/ISA, CFSA Officer/Official
Club Officer/Board Member
Other
Are you a skating coach? Yes No
How Long?
Are you compensated for coaching? Yes No
Have you ever been reinstated as a
member in good standing with any other
skating organization?
Yes No
Type your Full Name:
Enter the last 4 digits of your social security
number to serve as an electronic signature: