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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.
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Email
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Your email
Legal First Name
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Your answer
Legal Last Name
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Your answer
Phone Number
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Your answer
Mailing Address
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Your answer
Paypal Email
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Your answer
Google Drive Email
If this is the same as Paypal, you can skip this. If you use a different email for google drive access, list it here.
Your answer
Date of Birth
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If you are under 18, please contact our Juniors league at
goldcoastjrrollerderby@gmail.com
. If it's taking too long to get to your birth year, just get teh right date and leave a note in the comments at the end. We can fix that for you.
MM
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DD
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Emergency Contact Name
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Your answer
Emergency Contact Number
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Your answer
Emergency Contact Relationship
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Your answer
Do you have any allergies or medical conditions that we should be aware of for you safety? Also, please list your blood type.
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i.e. asthma, diabetes, epilepsy, allergies, chronic pain
Your answer
What are your preferred pronouns?
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She/Her
He/Him
They/Them
Other:
What's your nickname?
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Your answer
What type of membership are you looking for?
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New Skater
New NSO
New Ref
New Volunteer
Transfer Skater
Transfer NSO
Transfer Ref
Transfer Volunteer
Info Update; I'm a current GCDG Member
Returning Skater From LOA\Retirement
Dual Charter Skater
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