Please complete this form and return it carl Michael rossi at
lhdragon@... before February 20. Thanks!
LAST NAME
FIRST NAME
SKATE SCHOOL
ADDRESS
CITY
STATE / PROVINCE
COUNTRY
POSTAL CODE
PHONE
FAX
EDDRESS
WEBSITE
SPECIALTY AREAS
CERTIFIED INSTRUCTOR?
WHEN?
WHERE?
BY WHOM?
NOT CERTIFIED?
DESCRIBE YOUR INSTRUCTION EXPERIENCE
NOT AN INSTRUCTOR?
DESCRIBE YOUR INTEREST IN INLINE SKATING
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