MERCIAN ICE DANCE CLUB Chairman: Julia H. Greenhough

"Leaholme", 55 St. John's Hill, Shenstone, Staffordshire WS14 0JD Telephone: 07836 200 963 / 01543 483126 e-mail: mercian.icedanceclub@btopenworld.com web site: www.mercian-icedanceclub.com COMPETITION AT SOLIHULL ICE RINK Hobs Moat Road, Solihull B92 8JN Telephone 0121 742 5561

ENTRY FORM
BRITISH SOLO ICE DANCE QUALIFYING EVENT
SOLIHULL ICE RINK -MONDAY 26th MARCH 2007

Please use one form for each skater. Forms may be photocopied.

SURNAME:	FIRST NAME :
DATE OF BIRTH:	CLUB / RINK (For documentation & announcements)
NISA Number
Contact Telephone Numbers:
Email Address:
Home Address: Post Code:
CURRENT test standard COMPULSORY DANCE Date Attained:
CURRENT test standard ORIGINAL DANCE Date Attained:	CURRENT test standard DANCE MOVES / FM Date Attained:
British Solo Dance Qualifier entered. Competition 1 - 5 Fee: £32	Competition No. Competition Level: Is this your preferred qualifier: YES / NO
2nd British Solo Dance Qualifier entered. Competition 1 - 5 Fee: £32	Competition No. Competition Level: Is this your preferred qualifier: YES / NO

N.B. Incomplete Forms will be returned to sender - please ensure completed fully
Closing date for receipt of entries (Saturday 10th March 2007)

DECLARATION: I am an eligible skater (parent of skater aged under 18 years) as defined by
NISA and agree to abide by the rules of the competition.
I agree that the information provided may be stored on computer(s)
for administration of the competition(s) entered.

Skater / Parent

Date: