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 *
Legal First Name *
Legal Last Name *
Link to your Facebook Page *
We communicate mostly through facebook. So, connect with us so we can send you stuff!
Phone Number *
Mailing Address *
Paypal Email *
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.
Date of Birth *
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.
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Emergency Contact Name *
Emergency Contact Number *
Emergency Contact Relationship *
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
What are your preferred pronouns? *
What's your nickname? *
What type of membership are you looking for? *
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