Name:  ____________________________     Sex: M / F

Address:___________________________     Age Group:  <20   circle one
                                                    21-30
        ___________________________                 31-40
                                                    >40
        ___________________________

Phone: _________________  Fax: ____________________  e-mail: _________________

Do you actively race?  Yes / No   If yes, number of years racing ______________
Do you skate primarily indoors or outdoors? ___________________________________
Club Affiliation (if any): ____________________________________________________

Best 10 k time:
 <17 minutes  ______            Would you classify yourself as:
17-18 minutes ______
18-19 minutes ______               Experienced or Elite
19-20 minutes ______                    (circle one)
>20 minutes   ______

Where did you hear of this seminar: __________________________________

Have you ever attended other in-line clinics/seminars? Y / N
If yes, where? by who? _____________________________________________

Have you arranged your own accommodation and transportation while in Toronto? Y / N

If no, would you like to try and "billet" with a local skater? Y / N

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

The registration fee is only $80 Canadian funds. CIRSA members are eligible for a 10 % discount. Also, Hyper Wheels and SKF Bearings will be available at AMAZING! prices!

Mail completed registration form to:
CIRSA
#117-679 Queen's Quay West
Toronto, Ontario, Canada
M5V 3A9
(416) 260-0018

Bell Mobility - Your Friend On The Go

For more info, please contact CIRSA.