HOLLYDELL FIGURE SKATING CLUB TEST APPLICATION
                                                              Test Date:_________________ 

Candidate's Name:_______________________________________________USFSA #:_________________

Street Address:_______________________________________________Telephone:_________________ 

City/State/Zip:__________________________________________________________________________
 
Highest Test Passed:____________________ Home Club:______________________________________

Partner's Name:____________________________________________Partner's USFSA #:____________

Signature (Parent if Under 18):__________________________________________________________

Professional's Name (print):_________________________Signature:__________________________

CHECK ONE OF THE FOLLOWING:
                CLUB & USFSA                CLUB & USFSA                  CLUB & USFSA 
                    FEE	         	        FEE                           FEE
MOVES IN THE FIELD          FREE SKATING                PAIRS (per skater)     
o PRE-PRELIMINARY   $15	    o PRE-PRELIMINARY   $10     o PRELIMINARY	      $15
o PRELIMINARY	    $20	    o PRELIMINARY       $12     o JUVENILE	      $18
o PRE-JUVENILE	    $25     o PRE-JUVENILE      $15     o INTERMEDIATE	      $20
o JUVENILE	    $25	    o JUVENILE          $18     o NOVICE              $25
o INTERMEDIATE	    $30	    o INTERMEDIATE      $20     o JUNIOR              $30
o NOVICE	    $30	    o NOVICE	        $25     o SENIOR              $35
o JUNIOR            $35	    o JUNIOR	        $30
o SENIOR	    $35	    o SENIOR	        $35		
                                                          FREE DANCE (per skater) 
                                                          o JUVENILE	      $12
DANCE						          o INTERMEDIATE      $15
o PRELIMINARY	  $12 ea.  o DW  o CT  o RB	          o NOVICE            $20
o PRE-BRONZE      $13 ea.  o SD  o CC  o FT	          o JUNIOR            $30
o BRONZE	  $14 ea.  o HH  o WW  o TF	          o SENIOR            $35
o PRE-SILVER	  $20 ea.  o EW  o FT  o 14S
o SILVER	  $25 ea.  o AW  o RF  o T                      Moves in 
o PRE-GOLD	  $30 ea.  o PD  o K   o BL	      ADULT    the field / Free Style       
o GOLD		  $35 ea.  o QS  o VW  o AT  o WW     PRE-BRONZE    o      o  $15 ea.
o INTERNATIONAL   $45 ea.  o R   o SW  o CON o AUS    BRONZE	    o      o  $20 ea.
                           o TR  o SAM o GW  o RW     SILVER	    o      o  $30 ea.
			   o YP			      GOLD          o      o  $40 ea.
  

LATE APPLICATIONS WILL BE ACCEPTED AT THE DISCRETION OF THE TEST COMMITTEE - A $10  
Late FEE WILL APPLY.  CANDIDATES WHO WITHDRAW AFTER THE DEADLINE DATE FORFEIT TEST 
FEES UNLESS THE TEST SESSION IS CANCELED OR JUDGES CANNOT BE OBTAINED FOR A PARTICULAR   
TEST. ALL FEES MUST ACCOMPANY THE APPLICATION.  SPACE IS LIMITED-APPLY EARLY.   

                                                   TOTAL CLUB & USFSA FEE: ____________ 
SEND APPLICATION TO:		                    
Donna McAllister-Andersen           NON-MEMBER FEE-$25.00: (if applicable) ____________	
211 Brookfield Rd.	                   
Cherry Hill NJ  08034		            LATE FEE- $10: (if applicable) ____________               
QUESTIONS-Call Donna McAllister-Andersen: 	          HOSPITALITY FEE: $  5.00   
               856-427-0531                                 
MAKE CHECKS PAYABLE TO: HOLLYDELL FSC                       TOTAL FEE DUE: ____________

APPLICANTS MUST BE AVAILABLE TO TEST AT LEAST 20 MINUTES BEFORE THEIR SCHEDULED TIME.   
     ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

PERMISSION TO TEST FOR NON-HOLLYDELL FSC MEMBERS

This certifies that ___________________________________ is a member in good standing  

of __________________________________  and has permission to test on the above date.  

Please send results to (include SASE) ___________________________________________

 
TEST CHAIR SIGNATURE:_____________________________________________________________