Roller Skating Association International

RSA Membership Application

Cost of Membership

Please complete a separate contract for each individual rink and use the pricing below on each contract.
Rink Cost *
Additional Persons (First two members are included) $25/ea
Additional Mailing Addresses $30/ea

Please complete all information on both pages of this contract for each individual rink. Please note that Rink Address is the physical address of your rink, Shipping Address is where you have large packages hand delivered (CAN NOT be sent to a post office box), and Mailing Address is where you have small mail sent (can include a post office box).

Skating Center Information

Skating Center Name *
Rink Address *
City *
State *
Zip Code *
Shipping Address *
(NO P.O. BOX ADDRESSES. This is where large packages should be sent or signed for.)
City *
State *
Zip Code *
Mailing Address *
(Can include PO Boxes. This is where small mail items should be sent.)
City *
State *
Zip Code *
Public Phone *
Best Phone or Cell Phone (non-published) *
Public Email *
Fax *
Website *
Main Contact Person *
Main Contact Title *
Skating Floor Size (W x L) (ft.) *
Building Size (W x L) (ft.) *
Did You: *
What Fountain Beverage Do You Serve? *
Type of Business Organization: *

Individual Member Names

Please print or type name(s) of person(s) who will represent the facility in the association. First two individuals are included. Each additional member name is $25. If more than 5, please include names and titles on a separate sheet of paper. Check one title. Email and phone information below is for office use only and will not be published.

Name 1. (Incl.) * Title *
Email * Direct Phone / Cell Phone *
Name 2. (Incl.) Title
Email Direct Phone / Cell Phone
Name 3. ($25) Title
Email Direct Phone / Cell Phone
Name 4. ($25) Title
Email Direct Phone / Cell Phone
Name 5. ($25) Title
Email Direct Phone / Cell Phone
Please note: There is a 4% processing fee for all credit card transactions.


Total Due Today: $ .00

Credit Card Type *
Credit Card Number *         
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Credit Card Email Address
Please click submit only one time.  The transaction may take several seconds.

Please select a Rink Cost to continue.