1. Chiangmai Ice Skating Series 2017
Send Entry Form & Fees to:
Sub-Zero Ice Skate Club
1839 Majorcineplex Bld. 4th FL. Pahyonyothin Rd.
Jomphon Jatujak Bangkok 10900
Tel: (66) FAX:(66) Website:
INDIVIDUAL ENTRY FORM
Chiangmai Ice Skating Series 2017
July 8th - 9th 2017
SKATER INFORMATION (Please fill-out the form CAREFULLY and COMPLETELY)
Name
(To Be Printed on the Competition Program Book)
Age
(As of Dec 8, 2016)
Gender
(Please Check the Box) M F
Rink
Country
Birth date
Coach
ISI Membership #
Exp
INDIVIDUAL EVENTS (Highest test levels must be registered with the ISIAsia by 8 June 2017)
Highest ISI Test Level:
(Tot 1-4 / Pre-Alpha - Delta / FS 1-10 or Bronze-Platinum)
Solo Spotlight (All Levels)
Solo Dance (1-10)
Character
Level
Dramatic
Figures (1-10)
(Level)
Solo Program (PA-DL, FS 1-10)
Light Entertainment
Figures
Stroking (AL-DL ONLY)
Rhythmic (FS 1-10 / Bronze - Platinum)
Free Figures
Artistic (FS1-10 / Bronze - Platinum)
Ball
Hoop
Ribbon
Creative Figures
Footwork (FS 1-10)
Open Freestyle Event (Choose Only 1)
Solo Compulsories (All Level)
Bronze (FS 1-3)
Silver (FS 4-5)
PLEASE NOTE:
Rhythmic : Can do more than 1 event with different program.
Any change to this original Entry Form will result in a change fee of US$25 PER CHANGE / PER SKATER.
ENTRY DEADLINE: Thursday, June 8, 2017
DOUBLE FEES APPLY AFTER THAT DATE
Gold (FS 6-7)
Platinum (FS 8-10)
Interpretive (FS1-10/ Bronze - Platinum)
Short Gold (FS 6-7)
Short Platinum (FS 8-10)
Solo Surprise (All Levels)
Hockey
Speed Racing (All Ages)
Skating
Shooting
Goalie
PARTNER EVENTS
Bronze
Low
Silver
Gold
Platinum New!
Partner Name
ISI Membership #
(PA-DL)
(FS 1-3/Bronze)
(FS 4-5 /Silver)
(FS 6-7 /Gold)
(FS 8-10/Platinum)
Jump & Spin Team
Couple Spotlight
(Choose One)
Character
Dramatic
Light Entertainment
Couple 1- 10
Level
SIM
MIX
Dance 1- 10
Level
SIM
MIX
Free Dance 1- 10
Level
SIM
MIX
Pair 1- 10
Level
FEES & PAYMENT (All amounts are US Dollars)
There will be NO REFUNDS. ISI reserves the right to limit the number of entries without notice. I skate at this competition at my own risk and hereby release ISIAsia, ISI-USA, the rink owners, rink management, rink staff, and event organizers from all liability for any accident or injury. I declare that the home rink listed above is the rink where I skate.
First Event : x USD$ 50 = USD$
Second Event : x USD$ 35 = USD$
Additional Events : x USD$ 25 = USD$
TOTAL PAYMENT = USD $
Skater Signature Parent Signature (if applicable) Date
NOTE: Membership must be current through event. All tests and memberships must be registered with the ISIAsia office in Hong Kong or ISI (U.S.) by June 8, 2017.
I declare that the information above is true, that this skater’s test(s) are registered with ISIAsia or ISI, that the skater is a current Individual or Professional Member of ISIAsia or ISI-USA, that this skater is skating in the proper levels and categories, and that the home rink is correct.
OFFICE USE ONLY
Payment Type: Amount:
Date Received: Initials:
Coach Signature Date