SEND ENTRY AND FEE TO:

1. SEND ENTRY AND FEE TO: Fuji Ice Palace Pte Ltd 2 Jurong East St 13 #03-01 Jurong Entertainment Centre Singapore 609731 Tel: 6565 1905 Fax: 6565 5957 Email: diana@fujiice.com.sg LOCAL / OVERSEASTEAM ENTRY FORM SKATE ASIA WINTER CLASSIC29 Nov. – 3 Dec. 2007 Please Print: Name of Group/ Name for Program Book Coach Name Home Rink Rink Phone No. Coach Email Address City Country Phone No: USE ONE TEAM ENTRY FORM PER TEAM / PER ENTRY – Complete information & signature is required. • Synchronized Formation Compulsories • Synchronized Formation Team • Synchronized Skating Compulsories • Synchronized Skating Team • Synchronized Dance • Production Team • Pattern Team • Kaleidoskate Team • Team Compulsories: __________ Level* • FS Synchro Team: __________Level* *(indicate Freestyle 1-10) • Family Spotlight • Team Surprise • Ensemble –NEW ! Age Group Category will be determined based on entries received for each event. FEE & PAYMENT Entries must be received by FIP before 30 October 2007.DOUBLE FEES APPLY AFTER 30 October 2007. All Team Entries SGD $25 Per Skater TOTAL PAYMENT = SGD $_________________ There will be NO REFUNDS. All memberships must be current through event. I declare that the information above is true, that all skaters have a current Individual Membership ISIAsia or ISI. I have informed all team members that they skate at their own risk at this competition, and hereby release ISIAsia, ISI, the rink owner, management, staff & organizers from all liability for any accidents or injury. Coach Signature Date OFFICIAL USE ONLY – PAYMENT: AMOUNT: Date Received: