WIFSA | World Inline Figure Skating Organization

WIFSA2014@gmail.com

Membership Application Form - Bulletin d'inscription

Club Name:

President:

Individual Name:

Gender: Male Female

Age:

Address:

City:

State:

Postal Code:

Country:

Phone:

Email:

List of Club Skaters

Name 1:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 2:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 3:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 4:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 5:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 6:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 7:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 8:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 9:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 10:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 11:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 12:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 13:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 14:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 15:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 16:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 17:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 18:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 19:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Name 20:

Gender: Male Female

Date of Birth:

Registered in a WIFSA Club:Yes No If no, please provide email:

Fee:

Type

SPONSORS:

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