INDIVIDUAL ENTRY FORM

Event Dates: October 16 − 18, 2014 Test & Entry Deadline: September 14, 2014

Website: www.therink-icearena.com

Please Fill-out the form carefully and completely.

SKATER INFORMATION (Please print)

Male / Female Family Name (Last Name) First Name ISI / ISIAsia Membership# Expiration Date

Home Rink Birth date – Day / Month / Year Age as of October 16, 2014

Address City State/Province ZIP

Country / Administrative Region Phone No. E-mail (Required)

INDIVIDUAL ENTRIES ( PLEASE CHECK CORRECT BOX )

Highest ISI Test Level _______________________ (Tot 1-4, Pre-Alpha to Delta, FS 1-10 or Bronze-Platinum)

Events for All Levels / Ages Solo Freestyle (Tot, PA-DL, FS 1-10) Solo Compulsories (All Levels)

Solo Spotlight (All Levels) Character Dramatic

Themed Light Entertainment (Require different program

for each joined Solo Spotlight events) Solo Surprise (All Levels) Speedracing (All Ages)

Events for Limited Levels Stroking (AL-DL only) Footwork (FS 1 – 10) Artistic (FS 1 – 10) Interpretive (FS 1 – 10)

Rhythmic Skating (FS 1 – 10) Ball Hoop Ribbon

Hockey Events

Skating Shooting Goalie

Open Freestyle Event Bronze (FS1-3) Silver (FS4-5) Gold (FS5-6) Gold Short (FS5-6) Platinum (FS7-10) Platinum Short (FS7-10)

Themed Spotlight for 2014 is “HEROES AND VILLAINS”

PARTNER ENTRIES ( PLEASE CHECK CORRECT BOX )

Low(PA-DL) Med(FS1-3) Int(FS4-5) High(FS6-10) Elite(FS8-10) Partner Name ISIAsia Members # Jump & Spin Team

Couple Spotlight Character Dramatic Light Entertainment

(Choose 1)

Themed Couple Spotlight Couple 1-10 Level ________ Sim Mix

Pair Level (1-10) ____ Open Level (B/S/G/P) ____

There will be NO REFUNDS. We reserve the right to limit the number of entries without notice. I skate at this competition at my own risk and hereby release ISI-USA, ISIAsia, the event organizer, host facility(ies) and its owner(s), officers, directors, officials and personnel from all liability for any accident or injury. I declare that the home rink listed above is the rink that I wish to represent. Upon entering this competition, I hereby agree that any photographs or video taken of me, by the event organizers or any authorized party, may be used exclusively for any purpose by the event organizer/ISIAsia or any other use authorized party. ( Please ensure to Sign Below) X X

Skater Signature Guardian/Parent Signature (if applicable) Date I declare that the information above is true, that this skater’s test(s) are registered with ISI-USA or ISIAsia, that the skater is a current Individual or Professional Member of ISI-USA or ISIAsia, that this skater is skating in the proper levels and categories, and that the home rink listed above is correct. ( Please ensure to Sign Below) X

Coach Signature (PLEASE PRINT NAME) Date Is the coach attending the event? Yes / No

FEES & PAYMENT NOTE: Membership must be current through event. All tests and memberships must be registered with the ISIAsia office in Hong Kong or ISI-USA by SEPTEMBER 14, 2014.

First Event USD 50 x 1 = USD 50 Second Event USD 35 x __ = USD ___ Additional Event USD 25 x __ = USD ___ TOTAL PAYMENT = USD ______

PLEASE NOTES: ANY CHANGES TO THIS ORIGINAL ENTRY FORM WILL

RESULT IN A CHANGE FEE OF US$25.00 PER CHANGE / PER SKATER. IF ACCEPTED, ENTRY FEES WILL BE DOUBLED AFTER ENTRY DEADLINE!

OFFICE USE ONLY Payment Type: Amount: Date Received: Initials:

A