Please list the Year(s) that you were/are a member of TEAM USA: (if any)
First Name:
Middle Name:
Last Name:
Preferred Name for Publication:
Street Address:
City:
State:
Zip Code:
Home Phone Number:
Cell Phone:
Email Address:
Please enter the address of your personal website/online diary/web log (blog):
Date of Birth:
Birthplace:
Height:
Weight:
Home town:
Current Residence:
Home town Newspapers (daily & weekly including City and State):

Television Networks (In your viewing area):

Education:
High School Attended:
Year of Graduation:
Location of High School:
Sports you competed in while in High School (include number of years):

High School Honors:

College Attended:
Year of Graduation:
Degree/Major:
Sports you competed in while in College (include number of years):

College Honors:

Occupation:
Current Employer:
Career Goals:

Current Skating Club (Name, City, State):
Coaches Name:
Coaches City, State, Phone Number:
Began Skating (age and year):
Number of years you have been competing:
Number of years involved in skating:
How did you become interested in skating?

What is your favorite competition?
Who is your favorite skater and why?

Recent skating highlights:

Favorite web links:

Favorite quote or term:

Favorite Food:
Favorite Movie:
Favorite place to shop:
Most prized posession:
Pets:
Most thrilling experience:

Most embarrasing experience:

Are you sponsored and if so, by whom:
Future goals you hope to obtain as a skater:

Team USA Sport Accomplishments:

Pan American Games (include years competed and finishes):

Awards, honors and statistics received in roller sports - (please make sure to include all statistics, medals, awards and honors):

Other awards and/or honors received outside of roller sports:

Other sports you participate in:
Who is your favorite sports figure:
Who is the person you most admire/greatest influence in your life and why:

List your hobbies:
What music do you listen to during training or competition?:
What makes you a unique and special person:

If you could pick one word to describe you, what would it be:
Anything else you would like us to know about you:

Family Information:
Father's Name:
Father's Occupation:
Mother's Name:
Mother's Occupation:
Brother's:
Sister's:
Spouse's (if married):
Children's Name and Ages:
Family Members Who Have Competed or Are Competing in Amateur or Professional Athletics:

Olympic Games:

Pan American Games:

World University Games:

Other Events/Sports:

Please specify your preferred size for the following articles of clothing using a unisex scale.
Note: If SMALL is too large, then please state X-SMALL.
T-Shirt/Tank:
Athletic Shorts:
Spandex Shorts:
Skin Suit:
Windbreaker Jacket:
Breakaway Pants:

If this form is being filled out by someone other than the athlete themselves, please provide your name and contact information below, including email address and phone number.