Date: ________________________________

Name: ________________________________

Address: _________________________________________

_________________________________________________

_________________________________________________

Phone: __________________________________

FAX: ____________________________________

E-mail: __________________________________

Age Group: circle one (optional)

• <20
• 21-30
• 31-40
• >40

Sex: M / F

Do you actively race? Yes / No

If yes, number of years racing ______

Do you skate indoors or outdoors? ______________________

Club Affiliation (if any) __________________________________

Best 10 k time:

• <17 minutes ___________
• 17-18 minutes ___________
• 18-20 minutes ___________
• 20-22 minutes ___________
• >22 minutes ___________
• Unknown ___________

Would you classify yourself as: Experienced / Elite (mark one)

Where did you hear of this seminar: ______________________________________

Have you attended other in-line clinics/seminars? Y / N

If yes, where? by who? ____________________________________________________

Have you arranged your own accomodations while in Toronto? Y / N

If no, would you like to try to "billet" with a local skater? ___________

For out of town skaters......do you need help with transportation, directions, etc. while in Toronto? Y / N

Any other comments:

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

The registration fee is $100 Canadian funds, payable by cash certified cheque, or money order to CIRSA. CIRSA members are eligible for a 10% discount.

**Also, Hyper Wheels and Boss Bearings will be available at AMAZING prices!**

For more info, please contact CIRSA.