NJC Club Registration Form

SOUTH AUSTRALIAN SYCHRONISED ICE SKATING CLUB INC.

(Affiliated with South Australian Ice Skating Association Inc.)
2020 MEMBERSHIP APPLICATION FORM
Application Type*

RenewalNew MembershipPrevious Member Rejoinig
Membership Class*

OrdinaryJunior MemberNon-Skating
Name*

First NameLast Name
SASISC Membership No:
Date of Birth: (New members to provide copy of Birth Certificate or Passport)

MonthDayYear
Date
Gender

MaleFemaleOther
E-mail*
Home Number

Area CodePhone Number
Mobile Number
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
For Junior Skating Members Only:
Parent(s)/Carer(s) Name(s):

First NameLast Name
Parent(s)/Carer(s) Name(s):

First NameLast Name
Parent(s)Carer(s) Email:
example@example.com
For Skating Members Only:
Test Levels: Synchronised, Dance, Singles
Synchronised Skating Experienced: Years & Team(s)
Application Declaration

(please read carefully before signing)
I hereby apply to renew my membership/become a member of South Australia Synchronised Ice Skating Club Inc. I agree to be bound by the Rules of the Club and to comply with the Club’s Behaviour Management Policy. I agree to pay all fees and other amounts owing to the Club when due for payment. I am aware of the insurance cover held by the Club and by Ice Skating Australia. I also agree to abide by the ISA and SAISA “Code Of Conduct” and all of SASISC’s Policies.
Signature*

Clear
Witness by:

First NameLast Name
Date

MonthDayYear
Date
For Junior Skating Members a Parent/Carer must also sign this Declartion
Signature*

Clear
Witnessed by:

First NameLast Name
Date

MonthDayYear
Date
For new membership applications and for previous members rejoining only
Proposed by:

First NameLast Name
SASIC Membership No.
Signature*

Clear
Seconded by:

First NameLast Name
SASIC Membership No.
Signature*

Clear
Are you are current member of another Club or intend to

YESNO
Name of the other Club you are a member of:

MEMBERSHIP 2020

AUDDescription

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

PO BOX 4019 SEATON SA 5023

email: sasisc@hotmail.com
Should be Empty:

SOUTH AUSTRALIAN SYCHRONISED ICE SKATING CLUB INC.

2020 MEMBERSHIP APPLICATION FORM

For Junior Skating Members Only:

For Skating Members Only:

Application Declaration