Nonqualifying February 24-27, SoBe Ice Fiesta Rancho 2400 North Rancho North Las Vegas, NV.

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1 SANCTIONED BY U.S. FIGURE SKATING & SKATE CANADA Nonqualifying February 24-27, SoBe Ice Fiesta Rancho 2400 North Rancho North Las Vegas, NV Registration: Secure online registration and credit card payment available at: Entry Deadline: February 1, 2011 (11:59pm if entering online with Entryeeze) Sponsored by Pacific Coast Adult Sectionals Page 1

2 Pacific Coast Adult Sectionals 2011 Nonqualifying Announcement GENERAL INFORMATION LOC: CHAIRMAN CO-CHAIRMAN REFEREE Karin Sirk Kim Culp Wayne Hundey REGISTRAR Laura Simone PRACTICE ICE Century Leigh Dates: February 24-27, 2011 Deadline: Entries must be received by February 1, 2011 or if completed online, must be completed by 11:59 pm, February 1, 2011 Late Entries: Location: Rink Size: Facilities: Sponsor: Sanction: Competition Rules: Late entries will be accepted at the discretion of the LOC and if accepted will incur a $30.00 late fee. SoBe Ice Fiesta Rancho, 2400 N. Rancho, North Las Vegas, NV For rink information only, call (702) OR (702) 647-RINK. Do not contact the rink for practice ice information; contact the appropriate listed person above. A single surface, 200 x 85 with rounded corners (standard NHL size). The ice surface is connected to the Fiesta Rancho Hotel & Casino, which includes several fast food restaurants, a buffet, Denny s, other restaurants, and a gift shop. Texas Station Hotel & Casino is directly across the street and it has a fast food court, CoCo s, a buffet, steak house, and Starbucks. Las Vegas Figure Skating Club U.S. Figure Skating The competition will be conducted in accordance with the rules of U.S. Figure Skating as set forth in the current 2010/2011 U.S. Figure Skating Rulebook except as specified in this announcement. Two entries in a single event constitute a competition. If an event has only one entry, you will be notified of your options. All decisions of the Chief Referee will be final. Eligibility: All competitors must be members in good standing of U.S. Figure Skating or Skate Canada. The rules for non US citizens can be found at (second heading). Age and test status as of February, 1, 2011 (close of entries), will determine classification. All skaters must skate at their test level. Pairs must meet the requirements listed in that section. At the referee s discretion, men and women may be combined into a single event; events may be divided or combined or cancelled. 2011Pacific Coast Adult Sectionals Page 2

3 Events: Age Categories: Events offered include: Free Skate, Pairs, Solo Dance, Couples Dance, and Interpretative. Levels are pre-bronze through Masters. All age categories may be divided or combined depending on the number of entries. The chief referee has authority to make this decision. Class I years of age Class II years of age Class III years of age Class IV years of age Class V 61 years of age and over Judging: Fees: Corrections: Returned checks: Cancellations and Refunds: Practice Ice: 6.0 will be used to judge all events of this competition. See entry form for schedule of fees A $30.00 fee will be charged for corrections submitted less than two weeks prior to the competition. A $35.00 fee will be payable to the Las Vegas FSC for any returned checks. In addition, the skater will not be permitted to skate until the appropriate fees have been paid (CASH OR MONEY ORDER ONLY), including the $35.00 returned check fee. There will be NO EXCEPTIONS!! Once entries have closed, entry fees are refundable only if the competition is not held per U.S. Figure Skating rule #3235. If there are not enough entries to hold an event and time allows, the referee may offer an exhibition in lieu of a refund for that event. The Processing fee portion of the fees is non-refundable. Practice Ice will be available during the competition. 30 minute sessions and 20 minute day of event warm up sessions will be offered. Music will be played on the 30 minute sessions only. Music will be played by draw. Music draw will take place on a first come, first served basis 30 minutes prior to the start of each session. There is no guarantee that everyone s music will be played, however every effort will be made to do so. There will be NO refunds on practice ice and practice ice is non-transferable. The practice ice schedule will be available on the entryeeze website after the schedule has been posted. Practice ice will be sold online until midnight February 21, Additional practice ice will be sold on site beginning Thursday, February 24. Competition Schedule: Official Schedule: It is left to the discretion of the Chief Referee as to order, time, and day of each event. Skaters should be prepared to skate at any time that their event may be scheduled. A tentative schedule will be available on the entryeeze website and the 2011 Pacific Coast Adult Sectional s website as soon as it is available The official schedule will be posted in the rink lobby during the event. All changes to the schedule will be noted on the posted official schedule and will serve as due notice. Please check the official schedule frequently. 2011Pacific Coast Adult Sectionals Page 3

4 Check In: Music: A registration desk will be established near the entrance of the rink and will be open one (1) hour before the first scheduled event each day of the competition. All competitors are requested to register upon arrival at the ice arena (no earlier than 60 minutes before your scheduled event). Events may be started early at the Chief Referee s discretion. Skaters must check in with the Ice Monitor 30 minutes before they are scheduled to skate. CD s ONLY!!!!!!!!!! CD s must be plainly marked with name, event, and length of music. No CD-RW accepted. Single track CD s only; no more than one program per CD. CD s must be turned in at the Registration Desk no more than 45 minutes prior to competing. We will not accept any responsibility for breakage or damage; however, every precaution will be used to safeguard music. Have a back-up copy available rink-side in the event that there is a problem with the first CD. After the event CD s will be available for pick up at the Registration Desk. Las Vegas FSC will not return any music by mail. Awards: Photos: Programs: Videos: Administration: Credentials: Medals to be awarded to 1 st thru 4 th place immediately following posting of group s results. Pictures of the top four skaters in each event will be taken on the podium following the posting of results. All skaters can also purchase individual pictures. Action photos of each skater will also be available. Programs of the competition are available for purchase as part of the application. A very limited amount of programs will be available for sale at the competition. Professional video taping of each event will be available. All U.S. Figure Skating Championship Competitions will be professionally videotaped and photographed. Individual videotaping of the competition in any form is not permitted. This rule will be enforced. Photographs are permitted for personal use only. There will be NO flash photography permitted in the arena. Thank you for your compliance with these policies. Result sheets for all events will be available for 25 each at the Registration desk. At the time of registration, each competitor will receive a credential. Credentials will also be issued to professionals. Credentials will allow admission to backstage areas of the competition. To be credentialed all professionals must be current members of U.S. Figure Skating and the PSA and have completed all requirements for U.S. Figure Skating s coach s registration. NO EXCEPTIONS WILL BE MADE. Coaches: Admission: Competitor s Party: In order to be allowed to instruct/coach all coaches must be U.S. Figure Skating members, PSA members, and have gone through the coach s registration process. There is no admission price for spectators. Children under the age of ten (10) must be accompanied by an adult at all times. Saturday night at Blue Agave at the Fiesta Rancho. See Party form for details. 2011Pacific Coast Adult Sectionals Page 4

5 Accommodations: Fiesta Hotel & Casino North Rancho Drive North Las Vegas NV February 24, 25, & 26- Blocked Room Rate Thursday, February 24- $29.00 Friday, February 25- $49.00 Saturday, February 26- $49.00 A $4.99 hotel service fee per night, will be applied to each room, which includes local daily newspaper, high speed internet in guest rooms, unlimited local calls and unlimited domestic long distance calls. Room rates will e subject to the prevailing room tax, which is currently 12% and subject to change. To make a reservation call (800) and identify themselves as attendees of the Pacific Coast Adult Sectionals. A credit card and deposit in the amount of one (1) night s room and tax charge is required upon making reservation. Individual reservations may be cancelled up to 48 hours prior to arrival without penalty. Cancellation within 48 hours prior to arrival will result in a penalty of one (1) night room and tax charge. THE DECISION OF THE REFEREE WILL BE FINAL ON ALL MATTERS. THE REFEREE, ALONG WITH THE COMPETITION COMMITTEE, SHALL HAVE THE RIGHT TO EXCLUDE ANY PERSON WHOSE BEHAVIOR IS UNRULY OR UNSPORTSMANLIKE. 2011Pacific Coast Adult Sectionals Page 5

6 WELL-BALANCED FREE SKATE Singles Events Skaters are to perform a program to music in accordance with the current US Figure Skating Rulebook, except as specified herein. All Section references stated below are from the current US Figure Skating Rulebook. EVENT QUALIFICATION DESCRIPTION DURATION (min:sec) Masters At least the standard junior free skate test, or prior to Oct. 1, 1977, the Per rule :40 max Senior 6th figure test Masters Junior The standard novice free skate test or prior to Oct. 1, 1977, the 4th figure test. No higher than the standard junior free skate test or, prior Per rule :40 max Masters Novice Masters Intermediate Adult Gold Adult Silver Adult Bronze Adult Pre-Bronze to Oct. 1, 1977, the 7th figure test The standard intermediate free skate test or prior to Oct. 1, 1977, the 3rd figure test. No higher than the standard novice free skate test or, prior to Oct. 1, 1977, the 5th figure test. The standard intermediate free skate test and no higher or, prior to Oct. 1, 1977, the 3rd figure test and no higher. Skaters must have passed at least one of the following: The adult gold free skate test The standard juvenile free skate test, and no higher standard free skate tests. If a skater has passed the standard juvenile free skate test on or after Oct. 1, 1994, and no higher standard free skate tests, the skater must compete in adult gold. Skaters may have passed: The 2nd figure test and no higher before Oct. 1, A any figure tests or moves-in-the-field tests after Oct. 1, Skaters must have passed at least one of the following: The adult silver free skate test and no higher adult free skate tests. Before Oct. 1, 1994, the standard juvenile free skate test and no higher standard free skate tests. On or after Oct. 1, 1994, the standard pre-juvenile free skate test and no higher free skate tests. Skaters may have passed: The 2nd figure test and no higher before Oct. 1, Any figure tests or moves-in-the-field test after Oct. 1, Skaters must have passed at least one of the following: The adult bronze free skate test and no higher adult free skate tests. The standard preliminary free skate test and no higher standard free skate tests. Skaters may have passed: The 2nd figure test and no higher before Oct. 1, Any figure tests or moves-in-the-field tests after Oct. 1, Test qualifications as of the closing date for entries: Passed no higher than the adult pre-bronze free skate test, or the pre-preliminary free skate test. Per rule 3771 Per rule 3776 Per rule 3781 Per rule 3791 Per rule 3801 Per rule :10 max 3:10 max 2:40 max 2:10 max 1:50 max 1:40 max 2011Pacific Coast Adult Sectionals Page 6

7 WELL-BALANCED FREE SKATE Pairs Events Skaters are to perform a program to music in accordance with the current US Figure Skating Rulebook, except as specified herein. All Section references stated below are from the current US Figure Skating Rulebook. EVENT QUALIFICATION DESCRIPTION DURATION Masters Pairs The first partner of a team in the adult masters pairs event must have passed at least one of the following tests: Any standard pair test at the intermediate level or higher. Any standard free skate test at the intermediate level or higher The second partner must meet the requirements for this level or must have passed no more than one level lower than the first partner (that is, the adult gold pair test, adult gold free skate test, standard juvenile pair test, or standard juvenile free skate test). For purposes of these requirements, the adult gold pair and free skate tests are considered to be one level lower than the standard intermediate pair and free skate tests. Per rule :40 max Adult Gold Pairs Adult Silver Pairs Adult Bronze Pairs Centennial Pairs One partner in the adult gold pairs event must have passed one of the following tests: The adult gold pair test but not the standard intermediate pair test The adult gold free skate test The standard juvenile pair test and no higher standard pair test The standard juvenile free skate test but no higher standard free skate test (see exception) The other partner must meet the requirements for this level or must have passed no more than one level lower than the first partner (that is, adult silver pair test, adult silver free skate test, standard preliminary pair test and/or standard juvenile free skate test). Exception: Pair teams in which at least one member has passed the standard juvenile pair test or the adult gold pair test may choose to compete in the adult gold pairs event even if one or both members of the team have passed a standard free skate test at the intermediate level or higher. One partner in the adult silver pairs event must have passed one of the following: The adult silver pair test and no higher adult pair test The adult silver free skate test but no higher adult free skate test (see exception below) The standard pre-juvenile free skate test but no higher standard free skate test (see exception below) The other partner must meet the requirements for this level or must have passed no more than one level lower than the first partner (that is, the adult bronze pair test, adult bronze free skate test, and/or standard preliminary free skate test). Either member of an adult silver pair team may have passed the standard preliminary pair test and/or the standard pre-juvenile pair test but no higher standard pair test. Exception: Teams in which at least one member has passed the adult silver pair test may choose to compete at the adult silver pairs level, even if one or both members of the team have passed the next level adult or standard free skate test (i.e. adult gold free skate test and/or standard juvenile free skate test, but no higher standard free skate test.) Each partner in the adult bronze pairs event must have passed one of the following tests: The adult bronze pair test and no higher adult pair test The adult bronze free skate test but no higher adult free skate test (see exception below) The standard preliminary pair test and/or standard pre-juvenile pair test The standard preliminary free skate test but no higher than the standard pre-juvenile free skate test (see exception) Exception: Teams in which at least one member has passed the adult bronze pair test or the standard preliminary or pre-juvenile pair test may choose to compete in the adult bronze pairs event even if one or both partners have passed the next level adult or standard free skate test (that is, the adult silver free skate test and/or the standard pre-juvenile free skate test, but no higher adult or standard free skate test) Both partners must have passed at least one of the following tests and must be 50 years of age or older at close of entries: The adult silver pairs test The adult silver free skate test The standard preliminary or pre-juvenile pairs test The standard pre-juvenile free skate test There is no maximum limit on tests passed Teams that enter Centennial Pairs may not enter any other open pairs event Per rule 4121 Per rule 4123 Per rule 4125 Per rule :40 max 2:40 max 2:10 max 3:10 max 2011Pacific Coast Adult Sectionals Page 7

8 COUPLES DANCE Events Adult dance groups are open to skaters at least 21 years of age at close of entries. For the Adult Centennial dance event both partners must be at least 50 years of age at close of entries. Music for compulsory dances will be provided by the LOC. Please refer to US Figure Skating charts in the current rule book. ADULT GOLD DANCE (per rule 4471 & 4472) Test qualifications as of the closing date for entries: One partner must have passed at least one standard, adult or masters gold dance; the other partner must have passed at least one standard, adult or masters pre-gold dance. Any skater who has passed one or more pre-gold dance(s) prior to age 21 or has competed in any standard track qualifying dance event at sectionals or higher before or after the age of 21 will be ineligible to compete in this event. GROUP 1 FREE DANCE 3:10 max INITIAL ROUND Quick Step & Argentine Tango FINAL ROUND Free Dance ADULT PRE-GOLD DANCE (per rule 4481 & 4482) One partner must have passed at least one standard, adult or masters pre-gold dance; the other partner must have passed at least one standard, adult or masters silver dance. Neither partner may have completed the standard, adult or masters gold dance test. GROUP 1 FREE DANCE3:10 max INITIAL ROUND Blues & Starlight Waltz FINAL ROUND Free Dance MASTERS OPEN DANCE (per rule 4484 & 4485) One partner must have passed at least one standard, adult or masters gold dance; the other partner must have passed at least one standard, adult or masters pre-gold dance. GROUP 4 FREE DANCE3:10 max INITIAL ROUND Quickstep & Tango Romantica FINAL ROUND Free Dance ADULT SILVER DANCE (per rule 4491 & 4492) One partner must have passed at least one standard, adult or masters silver dance; the other partner must have passed at least one standard, adult or masters pre-silver dance. Neither partner may have passed more than one standard, adult or masters pre-gold dance. GROUP 2 INITIAL ROUND European Waltz & Rocker Foxtrot FINAL ROUND American Waltz & Tango ADULT PRE-SILVER DANCE (per rule 4496) Both partners must have passed at least one standard, adult or masters pre-silver dance. Neither partner may have passed more than one standard, adult or masters silver dance. GROUP 2 INITIAL ROUND Ten-Fox & European Waltz FINAL ROUND Fourteenstep & Tango 2011Pacific Coast Adult Sectionals Page 8

9 ADULT BRONZE DANCE (per rule 4501) One partner must have passed at least one standard, adult or masters pre-silver dance; the other partner must have passed at least one standard, adult or masters bronze dance. Neither partner may have passed more than one standard, adult or masters silver dance. GROUP 2 INITIAL ROUND Swing Dance & Fiesta Tango FINAL ROUND Willow Waltz & Fourteenstep ADULT PRE-BRONZE DANCE (per rule 4506) Both partners must have completed the standard, adult or masters pre-bronze dance test but no higher than the standard, adult or masters bronze dance test. GROUP 2 INITIAL ROUND Canasta Tango & Swing Dance FINAL ROUND Fiesta Tango & Willow Waltz ADULT CENTENNIAL DANCE (per rule 4511) Both partners must have passed one standard, adult or masters pre-silver dance test with no maximum limit on tests passed. GROUP 2 INITIAL ROUND Foxtrot & Tango FINAL ROUND European Waltz & Paso Doble SOLO DANCE Events Adult dance groups are open to skaters at least 21 years of age at close of entries. Men and ladies will compete against one another. Respective gender specific steps will be skated by each gender. Music for solo dances will be provided by the LOC. ADULT GOLD SOLO DANCE Skater must have passed at least one standard, adult or masters pre-gold dance. DANCE ONE Blues DANCE TWO Quickstep ADULT SILVER SOLO DANCE Skater must have passed at least one standard, adult or masters pre-silver dance and no higher than one standard, adult or masters pre-gold dance. DANCE ONE European Waltz DANCE TWO Rocker Foxtrot ADULT BRONZE SOLO DANCE Skater must have passed the complete standard, adult or masters preliminary dance test and no higher than one standard, adult or masters pre-silver dance. DANCE ONE Fiesta Tango DANCE TWO Willow Waltz 2011Pacific Coast Adult Sectionals Page 9

10 INTERPRETIVE Events Adult and masters interpretive free skate events shall consist of a variety of skating moves and elements selected for their value in enhancing the skater s interpretation of the music. Skaters may enter ONE or BOTH categories of interpretive skating. Costumes that enhance the performance by appropriately reflecting the character of the music and theme will be considered in the judging. LIGHT ENTERTAINMENT/COMEDY: A program designed to be light-hearted, entertaining, upbeat, clever, comedic, or that incorporates some kind of gimmick. ARTISTIC/DRAMATIC: A program of serious, emotional artistic interpretation designed to simply interpret the music which conveys an emotion other than humor. MASTERS INTERPRETIVE FREE SKATE (per rule 3810 & 3811) Must meet the requirements for the adult gold free skate event, any master s free skate or pair s event, or have passed at least one adult or standard silver dance test. No Axels or multi-revolution jumps. No props on the ice. Use of skating skills to develop a theme and interpret music, and effectiveness of the costumes will be reflected in the marking. 1:40 MAX ADULT INTERPRETIVE FREE SKATE (per rule 3820 & 3821) Must meet the requirements for the adult bronze free skate event or the adult silver free skate entries event or have passed the complete pre-bronze dance test, and have passed no higher than the complete adult pre-silver or standard pre-silver dance test. No Axels or multi-revolution jumps. No props on the ice. Use of skating skills to develop a theme and interpret music, and effectiveness of the costumes will be reflected in the marking. 1:40 MAX ADULT NO TEST INTERPRETIVE FREE SKATE Skaters need not have passed any tests, but may not have passed the adult bronze free skating test, the pre-bronze dance test, the preliminary tests. No Axels or multi-revolution jumps. No props on the ice. Use of skating skills to develop a theme and interpret music, and effectiveness of the costumes will be reflected in the marking. 1:40 MAX COACHES INTERPRETIVE FREE SKATE Skater must be at least 21 years of age by application deadline and must be a registered member of PSA or the Canadian Professional Skaters Association. A skater may not enter any other free skate or interpretive event. No Axels or multi-revolution jumps. No props on the ice. Use of skating skills to develop a theme and interpret music, and effectiveness of the costumes will be reflected in the marking. 1:40 MAX 2011Pacific Coast Adult Sectionals Page 10

11 Pacific Coast Adult Sectionals 2011 PLEASE PRINT CLEARLY & FILL EVERYTHING IN SKATER PROFILE Name: Address: Street City State Zip Home Phone: Cell Phone: Date of Birth: Age as of 2/1/2011: Sex: Male Female U.S. Figure Skating #: Home Club: Highest U.S. Figure Skating Tests Passed: Moves Free Skate Pairs Dance Partner s Name (if applicable): Coach s Phone: Coach s Name: Coach s A. SKATER AUTHORIZATION: The undersigned approves of the entry and agrees to hold harmless U.S. Figure Skating, the Las Vegas Figure Skating Club, and the SoBe Ice Arena at Fiesta Rancho from any and all loss, damages and/or injury of whatsoever kind or nature, that may be sustained by the entrant in any manner while participating in any activities of said competition. Signature of Competitor Print Name Date B. COACH AUTHORIZATION: : I hereby approve the entry of the above named entrant in the event(s) entered and certify that they are in accordance with the 2011 Pacific Coast Adult Sectionals Nonqualifying. Signature of Coach Print Name Date Coach U.S. Figure Skating # C. CLUB AUTHORIZATION: I hereby approve the entry of the above named entrant and certify to the best of my knowledge that he/she is a full member of my club, is in good standing, is registered through my club with U.S. Figure Skating, is eligible to enter the event(s) specified, and is an Eligible Person (Amateur) as defined in the Official Rules of U.S. Figure Skating. Signature of Club Official Print Name & Title Date THE ABOVE SIGNATURES ARE REQUIRED ON ALL MAILED ENTRY FORMS 2011Pacific Coast Adult Sectionals Page 11

12 ENTRY EVENTS NAME: Please double check the event(s) you have entered. CIRCLE APPROPRIATE AGE CATEGORY Class I Class II Class III Class IV Class V (21-30) (31-40) (41-50) (51-60) (61 & over) CHECK ALL EVENTS TO BE ENTERED Singles Events Couples Dance Events Solo Dance Events Masters Senior Masters Open Dance Adult Gold Solo Dance Masters Junior Adult Gold Dance Adult Silver Solo Dance Masters Novice Adult Pre-Gold Dance Adult Bronze Solo Dance Masters Intermediate Adult Silver Dance Adult Gold Adult Pre-Silver Dance Pairs Events Adult Silver Adult Bronze Dance Masters Pairs Adult Bronze Adult Pre-Bronze Dance Adult Gold Adult Pre-Bronze Adult Centennial Dance Adult Silver Adult Bronze Centennial Interpretive Free Skate Events Light Entertainment/Comedy Masters Interpretive Free Skate Adult Interpretive Free Skate Adult No Test Interpretive Free Skate Interpretive Free Skate Events Artistic/Dramatic Masters Interpretive Free Skate Adult Interpretive Free Skate Adult No Test Interpretive Free Skate Coaches Interpretive Free Skate FEES If you mail this application to registrar add the processing fee per event and if you use the electronic registration (preferred method) you will incur a 3.5% processing fee for separate orders, both processing fees are non-refundable Entry Fees: First Solo Event $ $10.00 = Second Event $ $5.00 = Additional Events x $ x $5.00 = First Partnered Event (per skater) $ $10.00 = Second Partnered Event (per skater) $ $5.00 = TOTAL DUE OFFICE USE ONLY Date payment received: Check #: Received by: Check amount: 2011Pacific Coast Adult Sectionals Page 12

13 CERTIFICATION BY ATHLETE NAME: Athlete: I agree to conduct myself, both on and off the ice, in a manner that will reflect favorable upon this competition and upon the sport of figure skating, and that is consistent with the high standards of the sport. I agree to respect the person and property of others, and in the event I cause injury, damage, or loss to another or to the property of another, I hereby indemnify U.S. Figure Skating, SoBe Ice Rink, Fiesta Hotel and Casino, the Local Organizing Committee, the Las Vegas Figure Skating Club, and their officers, directors, members, committees, representatives, employees and agents, and agree to hold them harmless against any and all claims that another person may have or which may arise out of such injury, damage, or loss, together with any reasonable costs and attorney s fees that may be incurred as result of any such claims, whether valid or not. Athlete: I understand that U.S. Figure Skating and the Las Vegas Figure Skating Club or organizers of this competition undertake no responsibility for damages or injuries, or loss of property suffered by the competitors. As a condition of and in consideration of the acceptance of their entries or participation therein, all entrants, their parents and guardians and officials shall be deemed to agree to assume all risks of injury to their person and property resulting from, caused by or connected with, the conduct and management of the competition, and to waive and release any and all claims which they may have against any officials, U.S. Figure Skating, Sobe Ice Rink, Fiesta Hotel and Casino, Local Organizing Committee, the Las Vegas Figure Skating Club, and their officers, directors, members, committees, representatives, employees and agents, and their entries shall be accepted only on such condition (see rule Athlete s Signature Date 2011Pacific Coast Adult Sectionals Page 13

14 AUTHORIZATION & CONSENT FOR MEDICAL ATTENTION OR TREATMENT PLEASE PRINT CLEARLY Name: Home Phone #: Address: Street City State Zip Emergency Contact: Emergency Contact #: Alternative Contact: Alternative Contact #: I certify that I, the member/participant give my consent to U.S. Figure Skating, Las Vegas FSC, SoBe Ice Arena, Fiesta Hotel & Casino, and their applicable agents, directors, officers, administrators, employees, volunteers, instructors, trainers, other participants, and the applicable agents, directors, officers, administrators, employees, volunteers, instructors, and trainers of the facility where the activities are taking place to obtain medical care from any licensed physician, hospital, or clinic, including transportation and emergency medical service for myself/ourselves and/or said participant for any injury that could arise from participation in these activities. In the event I am unable to, I hereby give permission for any emergency medical treatment and further authorize and consent to the release of any pertinent medical information and records regarding the treatment, diagnosis, and/or examination to the medical committee of the competition, for which I am entered by the physician representative of the medical committee of the sanctioned competition in which I am entered. Athlete s Signature Date OPTIONAL INFORMATION (Not required) Name of Primary Physician: Telephone of Primary Physician: Name of Insurance Company: Policy number: Name of policyholder: PLEASE NOTE: If you have any allergies, pre-existing conditions or other conditions which should be provided as information for medical treatment, please notify your coach or include medical history in your important documents that you keep with you. 2011Pacific Coast Adult Sectionals Page 14

15 THE FOLLOWING NEED TO BE RECEIVED BY FEBRUARY 1, 2011 SKATER PROFILE ENTRY EVENTS (both online entry and hard copy entry) CERTIFICATION BY ATHLETE AUTHORIZATION & CONSENT FOR MEDICAL ATTENTION OR TREATMENT Entries received after the deadline will be accepted only at the discretion of the referee and the competition committee, as ice is purchased based on the number of entries. If accepted, a late entry fee of $30.00 will incur. There will be no refunds after close of entries. A $30.00 fee will be payable to the Las Vegas Figure Skating Club for any returned checks. Make Check out to: Las Vegas Figure Skating Club Mail to: Laura Simone PCAS Registrar 544 Playa Linda Place Las Vegas, NV For Questions Contact: Laura Simone FSrisky@msn.com or Karin Sirk quietkarin@aol.com (Mon.-Fri. between 2:30pm-9:00pm) (Sat.-Sun. 8:00am-9:00pm) Pacific Standard Time Zone 2011Pacific Coast Adult Sectionals Page 15

16 Pacific Coast Adult Sectional Championships 2011 PROGRAM INFORMATION This information will be used for skater profiles in the program book. Pictures are optional. PLEASE PRINT CLEARLY Name of Competitor: Name of Club: Event(s) Entered: Coach(s) Name(s): Choreographer(s) Name(s): For Pairs, Partner s Name: For Dance, Partner s Name(s): Enclose two (2) 5 X7 photographs in an envelope with this page. Label both photographs on the back lightly with the skater s name, home club, and event. Black and white or color photographs are acceptable; however, black and white will reproduce more clearly. Photo should be a head shot. You may also photos as a JPEG or WORD file to quietkarin@aol.com Your photos will be available for pickup at the registration desk. Every effort will be made to safeguard your photos and return them to you. However, the Las Vegas FSC accepts no responsibility for lost or damaged photographs. 2011Pacific Coast Adult Sectionals Page 16

17 NAME PRONUNCIATION FORM PLEASE PRINT CLEARLY Name: Phone #: Cell #: Events: Phonetic Pronunciation (please CAPITALIZE the accented syllable): First Name: Last Name: Example: Alysee Davis First Name: uh-lease Last Name: DA-vis VOLUNTEER OPPORTUNITIES PLEASE PRINT CLEARLY Name: Phone #: Cell #: Volunteer schedules will not be set until the competition schedule is completed, so we won t interfere with your events. I can help during the competition, please contact me I cannot help during the competition If you would like to help us out during the competition, we'd love to have you! Please check off as many items as you d like to help with. Your name and contact information will be passed on to the appropriate committee chair. Anywhere as needed Registration Ice Monitor Coaches check in Set-Up Take down Runner 2011Pacific Coast Adult Sectionals Page 17

18 Pacific Coast Adult Sectional Championships 2011 PLEASE PRINT CLEARLY PROGRAM ADVERTISING and SKATER GOOD LUCK ADS Name: Address: Street City State Zip Phone #: Cell #: The Souvenir Program Book is black and white, with the exception of the cover pages. The finished size is 8 ½ x11. Please join in supporting our event by purchasing advertising space in the program. With competitors from various parts of the west coast, your ad will be seen! Ads are also a great way to wish skaters luck, & let them see their name in print. Check the size of advertisement you are purchasing & make certain your ad fits within the specified measurements. Covers will be sold to earliest buyer. This is a donation to the Las Vegas Figure Skating Club (a 501-c3 organization) and may be tax deductible. BOARD BANNER (**see below for details) $ OUTSIDE BACK COVER-color (7 ½ x 10 ) $ INSIDE FRONT COVER-color (7 ½ x 10 ) $ INSIDE BACK COVER-color 7 ½ x 10 ) $ FULL PAGE (7 ½ x 10 ) $ HALF PAGE (7 ½ x 5 ) $ ¼ PAGE (3 ¾ x 5 ) $ BUSINESS CARD (attach business card) $ PERSONAL MESSAGE (we design) $ Total Amount Enclosed: $ write personal message here-max 150 characters **Board Banners are 72 inch long, come in color, and will be designed per your specifications and hung around the competition ice. Advertise your business, highlight your club, or congratulate your skater or coach. Just submit your design and we will take care of the rest. Please send correctly sized, black & white, camera- ready art or art in JPEG or WORD files can be ed to quietkarin@aol.com. OFFICE USE ONLY Date payment received: Check #: Received by: Check amount: 2011Pacific Coast Adult Sectionals Page 18

19 PROGRAM ORDER Name: Phone #: Cell #: PROGRAM SALES: We are taking pre-sale orders for competition programs at the cost of $ We will only have a limited amount of extra programs on hand during the competition at a cost of $ So order yours today. Quantity: x $15.00 = OFFICE USE ONLY Date payment received: Check #: Received by: Check amount: 2011Pacific Coast Adult Sectionals Page 19

20 THE FOLLOWING NEED TO BE RECEIVED BY FEBRUARY 1, 2011 PROGRAM INFORMATION NAME PRONUNCIATION FORM VOLUNTEER OPPORTUNITIES (optional) PROGRAM ADVERTISING and SKATER GOOD LUCK ADS (optional) PROGRAM ORDER (optional) A $30.00 fee will be payable to the Las Vegas Figure Skating Club for any returned checks. Make Check out to: Las Vegas Figure Skating Club Mail to: Las Vegas FSC Karin Sirk PO Box Las Vegas, NV For Questions Contact: Karin Sirk quietkarin@aol.com (Mon.-Fri. between 2:30pm-9:00pm) (Sat.-Sun. 8:00am-9:00pm) Pacific Standard Time Zone 2011Pacific Coast Adult Sectionals Page 20

21 Pacific Coast Adult Sectional Championships 2011 PLEASE PRINT CLEARLY COMPETITIOR S PARTY Name: Phone #: Cell #: WHEN: Saturday, February 26, 2011 TIME: WHERE: 7:30 pm-11:00 pm Blue Agave inside the Fiesta Hotel & Casino COST: Free for PCAS competitors to get in Non Competitors are $5.00 each (pre-paid) Non Competitors are $10.00 at the door Snacks and Finger Foods with CASH BAR Competitor s Name: Admission: FREE Guest Names: Admission: $ Guest Names: Admission: $ Guest Names: Admission: $ TOTAL DUE: The LOC reserves the right to cancel the party & refund fees, if there is a lack of interest. THIS FORM MUST BE RECEIVED BY FEBRUARY 5, 2011 Make Check out to: Las Vegas Figure Skating Club Mail to: Las Vegas FSC PO Box Las Vegas, NV If you have any questions, please contact Tina Gusman-Rieb Rieb1@cox.net (Mon.-Fri. between 3:00pm-9:00pm) (Sat.-Sun. 8:00am-9:00pm) Pacific Standard Time Zone OFFICE USE ONLY Date payment received: Check #: Received by: Check amount: 2011Pacific Coast Adult Sectionals Page 21