Laurel Ridge Skating Club Test Application - Dance Test Date : ____________ Time : ________________ Location : _____________ Skater’s name :

USFSA# :

Address : Phone : email :

Written permission from an officer of Home Club required for non-LRSC member

Home Club : Professional’s Signature :

Phone :

Please circle all tests that you would like to take. Compulsory Dance (Circle Appropriate Test) Standard, Adult, Masters, Solo Preliminary: DW, CT, RB Pre Bronze: SD, CC, FIT Bronze: HH, WIW, TF Pre Silver: 14S, EW, FT Silver: AW, T, RF Pre Gold: K, BL, PD, SW Gold: VW, WW, QS, AT International: AUS, CON, GW, MB, RW, SAM, TR, YP

$25.00 each $25.00 each $30.00 each $30.00 each $35.00 each $35.00 each $45.00 each $45.00 each

Free Dance (Circle Appropriate Test) Standard, Adult, Masters Juvenile Intermediate Novice Junior Senior

$35.00 each $40.00 each $50.00 each $60.00 each $65.00 each

Make your checks payable to : Total for all tests Laurel Ridge Skating Club Mail to : Test Chair Laurel Ridge Skating Club PO Box 1133 Danbury, CT 06813

Non-member fee Late application fee

$30.00 * $20.00

Grand total: *Note : Late application fee required after the due date.

Due Date : _________________