Skater Registration Form

1
Full Name* This field is required.
First Name
Last Name
2
Skater Name / Number* This field is required.
Derby Name
Number
3
Email Address* This field is required.
4
What skater position do you prefer?* This field is required.
Please Select
Please Select
Jammer only
Blocker only
Prefer to Jam but can Block if needed
Prefer to Block but can Jam if needed
Anything
5
What is your skill level?* This field is required.
Beginner
Intermediate
Advanced
6
WFTDA / USARS number (must be 18)* This field is required.
7
Who is your home team?
8
$5 Registration Fee
Pay now with credit card
Pay at the door
9
Registration Fee - $5.00
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Description
USD
+ OR enter a custom value
Credit Card
First Name
Last Name
Should be Empty: