APPLICATION TO PARTICIPATE AS A MEMBER OF A USA JUNIOR INLINE HOCKEY TEAM Team Selection made by Resume Only VIII FIRS Junior Men Inline Hockey World Championships – Toulouse, France – Arrival - Sunday, June 29, Official Training – Monday, June 30, Competitions - Tuesday, July 1 through Saturday, July 6, Departure July 7, 2014 - A team consisting of up to 16 athletes (including two goalies) will be selected to participate. II FIRS Junior Women Inline Hockey World Championships – Toulouse, France – Arrival - Sunday, July 6, Official Practice - Monday, July 7, Competitions - Tuesday, July 8 through Saturday, July 13, Departure - Monday, July 14, 2014. A team consisting of up to 16 members (including two goalies) will be selected. Junior Inline Hockey Athlete Eligibility:    

Not yet 19 years of age. Athletes born in 1995, 1996, 1997, 1998, 1999 and 2000 are qualified to compete in the 2014 FIRS Junior Championships Athletes must qualify by gender. Athlete must be a current member of USA Roller Sports (membership application must be completed and returned with trials application). First-time members must provide verification of birth date. USARS Membership expires 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/Cups.

Responsibility of Junior World Championship Teams – Athletes are required to cover the entire cost of their participation.

APPPLICATION FEE: $25 plus $50 cost of USARS membership. $75 must accompany this application -Deadline for Receipt – March 31, 2014. Team Selection Completed – April 4, 2014. Airline tickets purchased from Official Travel Agency -by April 15, 2014. Payments to USARS of $600 each, which covers the cost of hotel (shared room) with 3 meals, ground transportation, apparel and travel insurance – May 15 and June 1. Name:

_____________ ___________ Date of Birth:________________

Mailing Address:

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City:

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Daytime phone: (

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State: ____________________ Zip Code: ____________

_____ ________ Evening Phone: (

Cell Phone: (____)_________________________________ Fax: (

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Age as of December 31, 2014: _________

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Work Phone: (

)

______ ________ )_______________________

E-mail: ______________________________________________

Page 2 - Resume of Junior 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:

Goalie___, Offense___ , Defense___

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___ Name as it appears on card: Security Code:_______

Exp. Date: Card # _

Zip Code of Billing Address:_________

MARCH 31 IS THE DEADLINE FOR RECEIPT OF THIS APPLICATION AND TRIALS FEE. Submit them to:

USA Roller Sports, 4730 South Street, Lincoln, NE 68506, (402) 483-7551-phone, ext. 13, (402) 483-1465-fax

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, ✦ Assistant Valerie LEFTWICH ✦ General Secretary Alberto LASTRUCCI ✦ Chief Referee Gordon YOUNG ✦ Member Tomas BREZINA ✦ Member Keith NOLL

France Australia Italy Canada Czech Republic 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 teams will compete for a B World Cup by direct elimination.  Senior Women Championships: 16 Teams - There will be 4 groups (JM- A, B, C, D) playing a round robin to qualify 8 teams competing for gold, silver and bronze medals by direct elimination, 8 other teams will compete for a B World Cup by direct elimination.  Junior Women Championships: 8 teams, 2 groups will play a round Robin then 8 teams will compete for gold, silver and bronze medals by direct elimination.  Senior Men Championships: 24 Teams - Six groups (A, B, C, D, E, F) playing a round robin. Group A and B will qualify 6 teams, Group C, D, E and F will qualify 2 teams. These eight (8) teams will compete for Gold, Silver and Bronze medals by direct elimination. All other teams will begin new competitions named World Cup B and World Cup C for National teams with first, second and third medals. Note: Junior Age: The official FIRS Junior Championship age level for both male and female players is under nineteen (19). In accordance with the information given at Huntington Beach on 2013, July 14th, players born in: 1995, 1996, 1997, 1998, 1999, 2000 are eligible to play in 2014. OPENING AND CLOSING CEREMONIES  There will be an Opening Ceremony on June 30th and a Closing Ceremony on July 6th, common for Junior Men and Senior Women National Teams.  There will be an Opening Ceremony on July 7th and a Closing Ceremony on July 13th for Senior Men National Teams and Junior Women Teams. Details in Toulouse during the coaches meeting. TICKETING All information as well as booking will be on event web site around February 15th http://www.roller-inlinehockey-toulouse2014.com/tickets/ PUBLICATION OF SCORES A link will be:  on http://www.worldinlinehockey.org/ - CIRILH website  on http://www.roller-inline-hockey-toulouse2014.com/ Toulouse2014 official website  on http://www.rollersports.org/ - FIRS website.