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Name
Address
City State
Zip
Phone No.(____)
Date of Birth
Sex: M F
(Month) (Day) (Year)
USS Reg. #
Age as of 6/30/06 E-mail
Association
Club
Association Approval Signature
NOTE: Approval of the
Association President or Secretary is required on all entries
except Senior Division
skaters and Direct Members; Direct Members must have the
approval of a USS Level 1 certified coach.
Skater Signature & Date
Parent/Guardian Signature & Date
if Skater is Under 18
CHECK SKATERS CLASS (AGE AS OF
JUNE 30, 2006). PROVIDE BEST TIME FOR DISTANCE LISTED.
MASTERS 70+ (
) MASTERS
30-39 ( )
MASTERS 60-69 (
) **SENIOR
(Elite) ( )
MASTERS 50-59 (
) **INTERMEDIATE 17 and
older ( )
MASTERS 40-49 (
) **JUNIOR 16 and
younger ( )
SEED TIME:
1000m 500m
CLASS:
**JUVENILE 14 and younger (
) MIDGET 12 and younger ( ) PONY 10 and younger (
)
SEED TIME:
500m 333m
**Eligibility for Senior (elite)
Division:
All competitors must have reached the age of 12 as of June 30,
2006.
All athletes must submit a time trial standard form with
entry to participate, with a qualifying time of 1:38.00
for men and 1:46.00 for ladies. All qualified skaters are
eligible to skate the 9 lap time trial (note: per ISU rules,
a skater must have reached the age of 15 before July 1, 2006 to
be eligible to compete in the 2007 World Championships).
Based on the results of the 9 lap time trial, the top 16 men and
top 16 ladies will move into the Senior (elite) division –
by electing to skate the Senior division time trial all skaters
agree to skate the Senior division if finishing in the top 16 of
the
1000m time trial (and forfeit their chance to win the National
Championships in their age appropriate division).
The rest of the skaters move into the Intermediate or other
appropriate age division for the reminder of the Championships.
PROCEDURES OUTLINED IN ICE
CHIPS #87, Event Web Site and USS AGE CLASS RACING RULES
ENTRIES (with fee & other
required paperwork) MUST BE
RECEIVED BY
FEBRUARY 12, 2007.
LATE ENTRY: $90 fee ($40 + late
fee of $50), entry form and other required paperwork
must be received by 6 PM MST on February 19, 2007 to be
eligible to compete.
RETURN entry form, Waiver &
Release, & fee of $40 to: U.S. Speedskating
(Senior Division skaters
must also submit
Time Trial Standard
P.O. Box 18370
Form & Code of Conduct, if not on
file with USS)
Kearns, UT 84118 Fax: (801) 417-5361
r
Check attached, made payable to U.S. Speedskating.
Charge my
r
Visa
r
Master Card
r
American Express
Card #
Exp date
Name as it appears on card __ Signature
ALL PARTICIPANTS ARE REQUIRED TO
BE A CURRENT MEMBER OF U.S. SPEEDSKATING
ALL SENIOR DIVISION
SKATERS MUST HAVE A SIGNED US. SPEEDSKATING CODE OF CONDUCT
ON FILE
SENIOR SKATERS SHOULD
SUBMIT CODE OF CONDUCT WITH ENTRY IF NOT ON FILE (must
be dated after Nov 2005)
By signing this entry form,
all other skaters certify that he/she has read and understands
USS’s Code of Conduct and agrees to abide by it.
DRUG TESTING WILL BE DONE IN
SENIOR DIVISION
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