Joining Gold Coast Derby Grrls!!
Fill out this form to join Gold Coast Derby Grrls! We are a member of the Women's Flat Track Derby Association and are located in Fort Lauderdale, FL. You must be at least 18 to join. If you are under 18, please contact our Junior affiliate - goldcoastjrrollerderby@gmail.com.
Email address *
Legal First Name *
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Legal Last Name *
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Facebook Name *
How do we find you on the Face Space? FB Name, Email, Link to your page...?
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Phone Number *
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Mailing Address *
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Paypal Email
Skip this if you do not have paypal.
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Date of Birth *
If you are under 18, please contact our Juniors league at goldcoastjrrollerderby@gmail.com.
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Emergency Contact Name *
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Emergency Contact Number *
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Emergency Contact Relationship *
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Do you have any allergies or medical conditions that we should be aware of for you safety? Also, please list your blood type. *
i.e. asthma, diabetes, epilepsy, allergies, chronic pain
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What are your preferred pronouns? *
What's your nickname? *
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What type of membership are you looking for? *
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