WESTCHESTER FENCING CLUB

Membership Application

2006--2007

 

STUDENT INFORMATION:

Name:                          ____________________________________________________     

Address:                       ____________________________________________________

                                    ____________________________________________________

Male: ____       Female: _____             Age:   __________    D.O.B.  ________________

School: WAIS ____     SHS ____        Other:  ____________________________

Grade level:   _______ Years Fencing:  1          2          3          4          5         

 

PARENT INFORMATION:

Parent Name:   ___________________________________________________________

Home phone:    ___________________________________________________________

Cell phone:       ___________________________________________________________

Parent E-mail:   ___________________________________________________________

 

ALTERNATE CONTACT:  (someone other than listed above, for emergency use only)

Name:              ___________________________________________________________

Relationship:     ___________________________________________________________

Home phone:    ___________________________________________________________

Cell phone:       ___________________________________________________________

 

USFA MEMBERSHIP INFORMATION:   (required only if you plan to participate in area tournaments)

USFA Membership # ____________________________________   Class Rating __________

Have you applied for a current 2004/2005 USFA membership? 

    Yes____     No____     Not Yet ____     Don’t Plan To____

 

PLEASE LIST ALL PERSONAL GEAR YOU OWN:  (for club equipment inventory purposes)

_____  Sword (electric foil)

_____  Lame’ (foil)

_____  Body Cord (foil)

_____  Sword (electric Epee)

_____  Body Cord (epee)

_____  Jacket (foil/epee)

_____  Under-protector (foil/epee)

_____  Glove (foil/epee)

_____  Mask (foil/epee)

_____  Pants (foil/epee)