Skate City Free Family Skate Club

Yearly Re-Occuring Membership

Membership*

Freebies Club Membership$5.00

Please select how many memberships you will be signing up for. Please note each membership must be for a specific person and must have their first and last name listed. Names will appear on membership as written on form.

Quantity
Item subtotal:$0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Rink*

Skate City Belleville (Belleville, Illinois)

Zip Code*

How many memberships are you signing up for?*

First Member's Name*

First NameLast Name

First Member's Age*

AdultYouth

Second Member's Name*

First NameLast Name

Second Member's Age*

AdultYouth

Third Member's Name*

First NameLast Name

Third Member's Age*

AdultYouth

Fourth Member's Name*

First NameLast Name

Fourth Member's Age*

AdultYouth

Fifth Member's Name*

First NameLast Name

Fifth Member's Age*

AdultYouth

Sixth Member's Name*

First NameLast Name

Sixth Member's Age*

AdultYouth

Contacts Name*

First NameLast Name

Contacts E-mail*

Contacts Phone Number*

Total Cost $

* Parent must be registered and attend for specials
* Everyone must show registration each day to receive these membership perks

Date

Expiration

Date

Skate City Belleville Family Freebies Club