RSA Membership Application

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: *

Build New RinkTake over existing rinkReinstate rink as member

What Fountain Beverage Do You Serve? *

PepsiCokeOther

Type of Business Organization: *

PartnershipProprietorshipCorporationOther

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

Name 1. (Incl.) *	Title *	Owner/OperatorOperatorManager
Email *	Direct Phone / Cell Phone *
Name 2. (Incl.)	Title	Owner/OperatorOperatorManager
Email	Direct Phone / Cell Phone
Name 3. ($25)	Title	Owner/OperatorOperatorManager
Email	Direct Phone / Cell Phone
Name 4. ($25)	Title	Owner/OperatorOperatorManager
Email	Direct Phone / Cell Phone
Name 5. ($25)	Title	Owner/OperatorOperatorManager
Email	Direct Phone / Cell Phone

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