APPLICATION TO PARTICIPATE AS A MEMBER OF A USA SENIOR INLINE HOCKEY TEAM Team Selection made by Resume Only XIII FIRS Senior Women Inline Hockey World Championships – Toulouse, France – Arrival - Sunday, June 29, Official Practice - Monday, June 30, Competitions - Tuesday, July 1 through Saturday, July 6, Departure - Monday, July 7, 2014. A team consisting of up to 16 members (including two goalies) will be selected. Partial funding as noted below will only be offered to 10 floor players and 2 goalies. Beyond that number must be responsible for all expenses. (USA departure and practice in Philadelphia on June 28) XX FIRS Senior Men Inline Hockey World Championships – Toulouse, France – Arrival - Sunday, July 6, Official Training – Monday, July 7, Competitions - Tuesday, July 8 through Saturday, July 13, Departure July 14, 2014 - A team consisting of up to 16 athletes (including two goalies) will be selected to participate. Partial funding as noted below will only be offered to 12 floor players and 2 goalies. Beyond that number must be responsible for all expenses. (USA departure on July 5) Women's Team Eligibility: Female athletes must meet the following criteria: Senior Minimum age is fourteen (14) years as calculated on January 1 in the year of the Championship. Athlete must be a current member of USA Roller Sports. A membership application is available at http://usarollersports.org/resources/forms - memberships expire annually on December 31 Passport proof of U.S. citizenship required - only U.S. citizens are eligible to represent our country at the FIRS World Championships. Men's Team Eligibility: Open to eligible male players who in 2013 have competed in national level events sanctioned by USA Roller Sports (including those co-sponsored by member organizations of USARS). In addition, selected athletes must meet the following criteria: Senior Minimum age is fourteen (14) years as calculated on January 1st in the year of the Championship. ADVISORY: It is recommended that USA male competitors, ages 14 and 15, should try out for the Junior Team USA. This will provide a better opportunity at the trials for success. As a Junior Team member they will obtain more playing experience at a World Championships in preparation for entry into the more experienced Senior level competitions. Athlete must be a current member of USA Roller Sports. A membership application is available at http://usarollersports.org/resources/forms - memberships expire annually on December 31. Passport proof of U.S. citizenship required - only U.S. citizens are eligible to represent our country at the FIRS World Championships. Responsibility of Senior World Championship Teams – The cost of participation is estimated to be up to $3,500, subject to air travel cost. Senior Team members must pay $1,995 toward this amount, which includes an estimated cost for international air travel, hotel with three meals a day, ground transportation in France, travel insurance, etc. Senior Women will meet in Philadelphia (domestic travel to Philly not in above budget). If flying from the West Coast, arrival in Philadelphia would be for early on June 28, to permit a couple of practice sessions in the morning and early afternoon, prior to departure for France. Travel for Senior Men to their USA international departure airport is not included in the budget above. APPPLICATION FEE: $75 (includes required USARS membership). $75 must accompany the membership and participation applications. Deadline for Receipt of Applications – April 7, 2014. Team Selection Completed – April 11, 2014. Team Deposit of $1,000 due - April 14, 2014. Balance not to exceed $995 due - May 15, 2014 Page 2 – Athlete Information/Payment APPLICATION TO PARTICIPATE AS A MEMBER OF A USA SENIOR INLINE HOCKEY TEAM Team Selection made by Resume Only Name: _____________ ___________ Date of Birth:________________ Mailing Address: ____ Age as of December 31, 2014: _________ City: ___ State: ____________________ Zip Code: ____________ Daytime phone: ( )__________________________ Evening Phone: ( )______________________________ Cell Phone: (____)______________________________ Work Phone: ( )_______________________ Fax: ( ) _____ E-mail: ______________________________________________ TRAVEL TO FRANCE: For additional information visit the US Government site: http://travel.state.gov/content/passports/english/country/france.html By my signature below, I agree to abide by the rules of USA Roller Sports and the United States Olympic Committee. I understand that if selected I will be representing the USA while in France, and acknowledge the inherent risk involved with participation. If selected for the team, I also agree to travel to the FIRS World Championships as a member of Team USA. Player's Signature: Date: Parent or Guardian if Minor Age: _____ Date: CREDIT CARD PAYMENT INFORMATION MasterCard___, Visa___, Discover___, American Express___ Exp. Date: Name as it appears on card: Card # _ Security Code:_______ Zip Code of Billing Address:_________ APRIL 7 IS THE DEADLINE FOR RECEIPT OF APPLICATIONS AND $75 TRIALS FEE. Submit them to: USA Roller Sports, 4730 South Street, Lincoln, NE 68506, (402) 483-7551-phone, ext. 13, (402) 483-1465-fax Page 3 - Resume of Senior Team Applicant Name:_________________________________________ Phone #, name and e-mail of coaches who you have played for:________________________________________ ____________________________________________________________________________________________ History of playing experience in roller and ice hockey, including any prior world teams, USARS and AAU inline hockey events, including any college team participation, listed in order of importance. ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Other experience that would support your request for a position on the USARS World Team: ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ EXPERIENCED PLAYER POSITION(S): Goalie___, Offense___ , Defense___ 2014 USA Roller Sports Inline Hockey Team USA Apparel and Equipment Sizes Athlete’s Name ____________________________________________________________ Team USA (check one): Junior Women ___, Junior Men ___, Senior Women ___, Senior Men ___ Preferred Player #: _________ or __________ Please circle your preferred choice. Uniform Jersey Size: S - M - L - XL – XXL (Ace Jersey) Uniform Pant Size: S - M - L - XL – XXL (Mission-Bauer) Team Shirt Size: S - M - L - XL – XXL Polo Shirt Size S – M – L – XL – XXL Team Shorts Size: M - L - XL – XXL (Bauer) Player Helmet Size: M - L - XL – XXL (Bauer) Glove Size: 11 – 12 – 13 – 14 – 15 (Mission-Bauer) Wheel Size: _____________________________________ STICKS NOT PROVIDED SO ATHLETES CAN USE THE STICK THEY ARE FAMILIAR WITH OFFICIAL PRACTICE AND COMPETITION DATES Junior Men Championship: June 30th, ending on July 6th. Senior Women Championship: June 30th, ending on July 6th. Junior Women Championship: July 7th, ending on July 13th Senior Men Championship: July 7th, ending on July 13th. COMPETITION VENUES "Palais des Sports" a nice venue where a rink around 50 by 25 meters (164 by 82 feet) with standard boards will be installed for the championships. The floor will be a SportCourt. "La Ramée" the home rink of Toulouse Roller Hockey. Despite the rink is smaller, the team from Toulouse play on Elite Group on French Elite Championship. There is a new SportCourt floor. CIRILH COMMITTEE AND RESPONSIBILITIES ✦ Chairman Gilbert PORTIER, France ✦ Assistant Valerie LEFTWICH Australia ✦ General Secretary Alberto LASTRUCCI Italy ✦ Chief Referee Gordon YOUNG Canada ✦ Member Tomas BREZINA Czech Republic ✦ Member Keith NOLL USA LOCAL ORGANIZATION Host Federation: Fédération Française de Roller Sports, 6 Boulevard du Pdt Franklin Roosevelt. CS 11742. 33080 Bordeaux Cedex – France - Website: http://ffroller.fr/! Toulouse Comité Local d'Organisation: Toulouse ComLor Evelyne BONNEGARDE ComLor President Sylvie ROMPTEAUX ComLor Coordinator E-mail: [email protected] Website:! http://www.roller-inline-hockey-toulouse2014.com/ "Welcome to TOULOUSE" information from Toulouse, Comité Local d'organisation available. In case you need to contact a person speaking english please send a mail to Thibaut Villemejane, [email protected] or call on Monday, Tuesday, Thursday or Friday to + 33 7 8175 6660 (avoid Wednesday, Saturday, Sunday). Junior Men Championships: 20 Teams - There will be 6 groups (JMtop8 - A, B, JMq - C, D, E, F) playing a round robin. Group A and B will qualify 6 teams, Group C,D,E, F will qualify 2 teams. These 8 teams will compete for gold, silver and bronze medals by direct elimination, 8 other