Change of Membership Category Form - February 2021 Step 1 of 4 25% What is your current membership category?*IntroductoryFamilySingleU.S./World Championships CompetitorOfficialsHonoraryTeamFriends of the ClubPlease provide the name of the team you have been participating in:*How many members are listed on your current membership?*1234567Member 1* First Name Last Name Member 2* First Name Last Name Member 3* First Name Last Name Member 4* First Name Last Name Member 5* First Name Last Name Member 6* First Name Last Name Member 7* First Name Last Name Home/Mailing Address* Street Address Address Line/P.O. Box City State/Province/Region ZIP/Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Primary Email Address* Primary Phone Number* What is your new membership category?*Please note that your change in membership category will become effective July 1, 2020. FamilySingleU.S./World Championships CompetitorTeamOfficialsFriends of the ClubPlease provide the name of the team you will be participating in:*Note: If you are submitting a form for multiple Team memberships, a separate entry must be completed for each applicant.How many adult candidates are included on your new membership?*12Note: For those submitting a form for a Team membership, at least one adult candidate must be included as the responsible billing party if the team member is under the age of 18.Name of Primary Adult Candidate* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Birthday* Date Format: MM slash DD slash YYYY Mobile PhoneU.S. Figure Skating NumberName of Additional Adult Candidate* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Birthday* Date Format: MM slash DD slash YYYY Mobile PhoneU.S. Figure Skating NumberHow many youth candidates are included on your new membership?*None12345Youth Candidate (1)*NameBirthdayU.S. Figure Skating Number (if applicable) Youth Candidate (2)*NameBirthdayU.S. Figure Skating Number (if applicable) Youth Candidate (3)*NameBirthdayU.S. Figure Skating Number (if applicable) Youth Candidate (4)*NameBirthdayU.S. Figure Skating Number (if applicable) Youth Candidate (5)*NameBirthdayU.S. Figure Skating Number (if applicable) I have received, read and understand The Skating Club of Boston Membership Guide and Club Rules, including rules regarding cancellation of my membership and responsibility for payment of all financial obligations, and agree to be bound by their terms and conditions.* YesElectronic Signature* First Last This signature must be completed by the primary adult candidate that is over the age of 18.