Lothian Derby Doll Membership Form and Waiver
Name *
Real Name
Your answer
Skate Name
As you would like to appear on all official documents.
Your answer
Skate Number
As you would like to appear on all official documents
Your answer
Address *
Your answer
Email address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
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