Please fill out the form and submit via internet.
Or, print this page, fill out and submit by fax to +81-3-3915-7486, or airmail to ISIJ, c/o Patine Corporation, 2-6-1 Sugamo, Toshima-ku, Tokyo 170-0002 Japan.



* mandatory field
Event Location Event Dates Entry Deadline
SKATE JAPAN 2004 SAITAMA, JAPAN May 30, 2004 May 1, 2004

Male
Female

First Name*　
Last Name*　
ISI Membership No.*
Exp. Date*
Birthdate* month dateyear
Age on 1st day of event*
Address*
Address 2
City*
State*
Phone #*
Postal Code*
Country
Home Rink Name*
Name of Skating Coach*
Email Address *

INDIVIDUAL EVENTS

Pre-Alpha - Delta
Solo
Stroking
Spotlight (choose 1)
Character
Dramatic
Light Entertainment

Speed Racing
Surprize Event

Indicate level (Pre-Alpha - Delta)

Check if applicable:
Special Skater

Freestyle (1-10)
Solo
Footwork
Solo Compulsories
Aristic
Interpretive
 Spotlight (choose 1)
Character
Dramatic
Light Entertainment

Speed Racing
Surprize Event
Indicate Level (1-10)

PARTNER ENTRIES Sim Mix Partner Name Partner ISI # Partner Age
as of Event
Couple  
Dance
Pair
Free Dance
Couple Spotlight Low
(Both skaters Pre-Alpha - FS3)
Choose one:
Char. Dram. Lt. Enter. 		         
Couple Spotlight High
(Either Skater FS4-FS10)
Choose one:
Char. Dram. Lt. Enter.		          

Registration Fees are non-refundable ISIJ reserves the right to limit the number of entries without notice.

By submitting this form, I understand that I skate at this competition at my own risk and hereby release ISIJ, the host rink, ISI Asia and their personnel from all liability. I declare that the home rink listed above is the true rink/club/school that I wish to represent.

By submitting this form and upon entering this competition, I hereby agree that any photographs or video tapes taken of me, by ISIJ or any authorized party, may be used exclusively for any purpose by the ISIJ or any other use authorized by ISIJ.


Fees


First Event = JPN Yen 5,000.-
Each additional = JPN Yen 2,000.-

Entry Fees are doubled after entry deadline!

Entry fees must be transferred by T/T in full no later than May 1, 2004 to the account of ISIJ. All bank charge is payable by the participants. All entry will be officially accepted upon receipt of both entry fees and forms.
Total Amount for Entry Fee* JPN Yen

Please confirm all information is filled in and press the SEND botton only ONCE.