U.S. Figure Skating Test Pin Order Form 1Member Information2Free Skate3Moves in the Field4Pairs5Ice Dance, Ice Dance Solo6Shipping Information7Billing Agreement Skater/Participant InformationClub Member Name (Primary)* First Last Club Account Number* Email*This is the email address that will be used for inquiries and email notifications. Enter Email Confirm Email Primary Phone Number*Delivery Method* Pick up at the Club Ship to me (U.S. only, $1.50 shipping fee) I would like to order the following types of pins:* Free Skate Moves in the Field Pairs Ice Dance Free Skate Test LevelSelect the level and number of pins desired.Pre-Preliminary Free Skate ($8.00/each)Select Amount12345Preliminary Free Skate ($8.00/each)Select Amount12345Pre-Juvenile Free Skate ($8.00/each)Select Amount12345Juvenile Free Skate ($8.00/each)Select Amount12345Intermediate Free Skate ($8.00/each)Select Amount12345Novice Free Skate ($18.50/each)Select Amount12345Junior Free Skate ($33.00/each)Select Amount12345 Moves In The FieldSelect the level and number of pins desired.Pre-Preliminary Moves ($8.00/each)Select Amount12345Preliminary Moves ($8.00/each)Select Amount12345Pre-Juvenile Moves ($8.00/each)Select Amount12345Juvenile Moves ($8.00/each)Select Amount12345Intermediate Moves ($8.00/each)Select Amount12345Novice Moves ($18.50/each)Select Amount12345Junior Moves ($33.00/each)Select Amount12345 PairsSelect the level and number of pins desired.Pre-Juvenile Pairs ($8.00/each)Select Amount12345Juvenile Pairs ($8.00/each)Select Amount12345Intermediate Pairs ($8.00/each)Select Amount12345Novice Pairs ($18.50/each)Select Amount12345Junior Pairs ($33.00/each)Select Amount12345 Ice Dance Pins, Bars and MedalsSelect the level and number of pins, medals, or bars desired.Preliminary Ice Dance Pins ($8.00/each)Select Amount12345Pre-Bronze Dance Pins ($8.00/each)Select Amount12345Bronze Dance Medal ($18.50/each)Select Amount12345Pre-Silver Dance Bar ($11.00/each)Select Amount12345Silver Dance Medal ($33.00/each)Select Amount12345Pre-Gold Dance Bar ($15.00/each)Select Amount12345Gold Dance Medal ($150.00/each)Select Amount12345Juvenile Free Dance Pins ($8.00/each)Select Amount12345Intermediate Free Dance Pins ($8.00/each)Select Amount12345Novice Free Dance Bar ($11.00/each)Select Amount12345Junior Free Dance Bar ($15.00/each)Select Amount12345Ice Dance Solo Pins, Bars and MedalsSelect the level and number of pins, medals, or bars desired.Preliminary Solo Dance Pins ($8.00/each)Select Amount12345Pre-Bronze Solo Dance Pins ($8.00/each)Select Amount12345Bronze Solo Dance Medal ($18.50/each)Select Amount12345Pre-Silver Solo Dance Bar ($11.00/each)Select Amount12345Silver Solo Dance Medal ($33.00/each)Select Amount12345Pre-Gold Solo Dance Bar ($15.00/each)Select Amount12345Gold Solo Dance Medal ($150.00/each)Select Amount12345Juvenile Solo Free Dance Pins ($8.00/each)Select Amount12345Intermediate Solo Free Dance Pins ($8.00/each)Select Amount12345Novice Solo Free Dance Pins ($8.00/each)Select Amount12345Junior Solo Free Dance ($8.00/each)Select Amount12345 Shipping AddressU.S. only, $1.50 shipping fee applies.Ship To:* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* I understand that all costs will be billed to my Club account.Electronic Signature* Type in full legal name.Questions & Comments: Δ
