American Snowsport Education Association - Central

Membership Application
3225 West St. Joseph, Lansing, MI 48917
PH: (517) 327-0601 FAX: (517) 321-0495

RENEWAL NEW MEMBER TRANSFER MEMBER INFORMATION:

If renewing, please indicate one of the following Identification numbers. If you
are not able to locate your identification number, leave the fields blank. BIRTHDATE:
Members must be at least 15 years of age.
NATIONAL ID NO.: DIVISION ID NO.:
MALE FEMALE
NAME:
PRIMARY DISCIPLINE:
ADDRESS:
Alpine Snowboard
Adaptive Nordic Track
City State Zip Telemark

PHONE: Home ( ) Work ( ) SKI SCHOOL: __________________

Fax ( ) Cellular ( ) MEMBERSHIP TYPE:

EMAIL: Student (ages 15 - 23 with proof of

enrollment)
Active (Teaching)
PAYMENT INFORMATION: Inactive (Not Teaching)
Alumnus (10+ years teaching, yet not
SEASON: ____________ currently teaching)
Paying by check (see enclosed) (Example: 2005/2006)
Division Only (Non-certified Instruc-
Paying by credit card: tors & Industry Supporting Members)

VISA Mastercard
MEMBERSHIP DUES:
AMEX Discover Exp. Date:
ACTIVE: $95.00
CC#: - - - STUDENT: $60.00
INACTIVE: $95.00
MEMBERSHIP DUES: $ INACTIVE: $45.00*
ALUMNUS: $95.00
BACK DUES / LATE FEES: $ ALUMNUS: $45.00*
DIVISION ONLY: $45.00
EDUCATION FOUDATION DONATION**: $ DIV. ONLY STUDENT: $25.00
*Does not receive National benefits and discounts.
TOTAL PAYMENT TO BE CHARGED: $
RENEWAL DUES SCHEDULE:
**The Education Foundation researches new techniques and methodologies of teaching snowsports, develops Add $10.00 if renewing after June 30th
safety programs for snowsports, and the development of skiing programs for the handicapped.
Add $15.00 if renewing after July 31th
Signature: Date:
Education Foundation Donor Release
By paying my ASEA-C membership dues I acknowledge that skiing or snowboarding can be a
hazardous sport and I hereby release ASEA-C, the host area and the directors, officers, agents and By checking this box, you are not
employees of each from liability for any and all injuries and damages of whatever nature arising allowing Central Division to use your name in
during or in connection with my participation in a ASEA-C event. public acknowledgement of your contribution
to the Education Foundation.