TEST APPLICATION & FEES

NAME	USFSA #				BIRTHDATE
ADDRESS
CITY			STATE			ZIP
PHONE	HOME CLUB
DATE OF LAST TEST		LOCATION
TEST(S) TO BE TAKEN
IF TEST IS TO BE TAKEN AS A DANCE OR PAIR, PLEASE LIST PARTNER:
NAME	USFSA#			HOME CLUB

THIS FORM MUST BE COMPLETED AND ALL FEES MUST ACCOMPANY THIS FORM OR APPLICATION WILL NOT BE ACCEPTED. MAKE CHECKS PAYABLE TO WYANDOTTE FSC AND RETURN TO TEST CHAIRMAN TEN DAYS PRIOR TO TESTING. LATE APPLICATIONS WILL BE ACCEPTED IF SCHEDULE ALLOWS AT A $15.00 LATE FEE.

!!!!!!!!!! ABSOLUTELY NO REFUNDS !!!!!!!!!!

MOVES-IN-THE-FIELD FEES:

PRE-PRELIMINARY.............................................................. $15.00

ADULT PRE-BRONZE.......................................................... $20.00

PRELIMINARY........................................................................ $20.00

ADULT BRONZE.................................................................... $25.00

PRE-JUVENILE...................................................................... $25.00

ADULT SILVER...................................................................... $30.00

JUVENILE............................................................................... $30.00

ADULT GOLD......................................................................... $40.00

INTERMEDIATE..................................................................... $40.00

NOVICE................................................................................... $45.00

JUNIOR................................................................................... $50.00

SENIOR................................................................................... $60.00

FREE SKATE FEES:

PRE-PRELIMINARY.............................................................. $10.00

ADULT PRE-BRONZE.......................................................... $15.00

PRELIMINARY........................................................................ $15.00

ADULT BRONZE.................................................................... $20.00

PRE-JUVENILE...................................................................... $20.00

ADULT SILVER...................................................................... $25.00

JUVENILE............................................................................... $25.00

ADULT GOLD......................................................................... $30.00

INTERMEDIATE..................................................................... $30.00

NOVICE................................................................................... $35.00

JUNIOR................................................................................... $45.00

SENIOR................................................................................... $50.00

PAIR TEST FEES (per candidate):

PRELIMINARY........................................................................ $13.00

ADULT BRONZE.................................................................... $13.00

ADULT SILVER...................................................................... $15.00

JUVENILE............................................................................... $15.00

ADULT GOLD......................................................................... $18.00

INTERMEDIATE..................................................................... $18.00

NOVICE................................................................................... $23.00

JUNIOR................................................................................... $28.00

SENIOR................................................................................... $35.00

FREE DANCE FEES (per candidate):

JUVENILE............................................................................... $18.00

INTERMEDIATE..................................................................... $20.00

NOVICE................................................................................... $23.00

JUNIOR................................................................................... $25.00

SENIOR................................................................................... $28.00

DANCE TEST FEES (per dance):

PRELIMINARY......................................................................... $ 7.00

Dutch Waltz, Canasta Tango, Rhythm Blues

PRE-BRONZE......................................................................... $ 8.00

Swing Dance, Cha-Cha, Fiesta Tango

BRONZE................................................................................... $ 9.00

Hickory Hoedown, Willow Waltz, Ten-Fox

PRE-SILVER........................................................................... $10.00

Fourteen Step, European Waltz, Foxtrot

SILVER.................................................................................... $12.00

American Waltz, Tango, Rocker Foxtrot

PRE-GOLD............................................................................. $14.00

Killian, Blues, Paso Doble

GOLD....................................................................................... $15.00

Viennese Waltz, Westminster Waltz, Quickstep, Argentine Tango

JUNIOR INTERNATIONAL................................................... $18.00

Rhumba, Starlight Waltz, Austrian Waltz, Cha Cha Congelado

SENIOR INTERNATIONAL................................................... $20.00

Samba, Yankee Polka, Ravensburger Waltz, Golden Waltz

FIGURE TEST FEES:

PRELIMINARY........................................................................ $16.00

ADULT BRONZE.................................................................... $16.00

FIRST....................................................................................... $17.00

ADULT SILVER...................................................................... $17.00

SECOND................................................................................. $20.00

ADULT GOLD......................................................................... $20.00

THIRD...................................................................................... $25.00

FOURTH.................................................................................. $30.00

FIFTH.................... (PART A OR B $30.00)............ FULL—$35.00

SIXTH.................... (PART A OR B $35.00)............ FULL—$40.00

SEVENTH............ (PART A OR B $40.00)............ FULL—$45.00

EIGHTH................ (PART A OR B $60.00)............ FULL—$65.00

ADDITIONAL FEES:

PRO FEE........................................................... TEST FEE + $ 5.00

JUDGE'S FOOD/TRAVEL FEE.............................................. $ 8.00

TEST FEES.................................................................. $_________

NON-MEMBER FEE (if applicable)......................... $_________

PRO FEE (if applicable)............................................ $_________

JUDGE'S FEE............................................................. $_________

TOTAL FEES................................................................ $_________

MAKE CHECKS PAYABLE TO: WYANDOTTE FSC

OVER è è è

ALL APPLICATIONS MUST BE SIGNED BY PARENT/GUARDIAN (if under 18) OR SKATER (if over 18) AND PROFESSIONAL:

PARENT__________________________________________ SKATER_____________________________________________

if under 18 if over 18

PROFESSIONAL___________________________________________

CERTIFICATION BY CLUB TEST CHAIRMAN

THIS IS TO CERTIFY THAT THE ABOVE NAMED IS A MEMBER IN GOOD STANDING WITH THE HOME CLUB INDICATED AND IS ELIGIBLE TO TAKE THE TEST APPLIED FOR.

SIGNED _____________________________________________

WFSC TEST CHAIRMAN:

"RECOGNITION OF TEST ACHIEVEMENT PROGRAM"

IF YOU WISH TO HAVE THE USFSA SEND A LETTER TO YOUR SCHOOL PRINCIPAL FOR HAVING PASSED USFSA TESTS, PLEASE INDICATE SAME BY PROVIDING THE FOLLOWING:

PRINCIPAL’S NAME_____________________________________________________________________________________

SCHOOL NAME_________________________________________________________________________________________

SCHOOL ADDRESS_____________________________________________________________________________________

______________________________________________________________________________________________________

THIS PROGRAM INCLUDES TESTS PASSED AT THE FOLLOWING LEVELS:

FIGURE TESTS: 4^th through 8^th

FREE SKATE TESTS: NOVICE through SENIOR

PAIR TESTS: NOVICE through SENIOR

MOVES TESTS: NOVICE through SENIOR

DANCE TESTS: COMPLETION OF THE SILVER, GOLD, SILVER FREE AND GOLD FREE

PLEASE SUBMIT THIS INFORMATION WITH THIS TEST APPLICATION.

09/01—bkk