RSC Membership Form
Email address *
Skater's Name: *
First and last name
Parent 1 Name: *
Parent 1 Cell #: *
Parent 2 Name:
Parent 2 Cell #:
Skater's Birthdate: *
MM
/
DD
/
YYYY
Mailing Address - Street: *
Mailing Address - City: *
Mailing Address - Zip Code: *
Skater's USFS Number:
In case of emergency, contact: *
Please list name & phone number
Additional notes regarding your skater (allergies, etc.):
Select Membership Package: *
Required
Select Billing Preference: *
Required
Skater (if 18+) or Parent/Guardian Signature *
I have read the membership packet completely and have complied with the Revolutions Member checklist:
Thank you for choosing Revolutions Skating Club.
We are looking forward to a great season!
A copy of your responses will be emailed to the address you provided.
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