RDAC MEMBERSHIP FORM 2013
Our Membership Policies for 2013 can be found on our website (http://rollerderbycanada.ca/?page_id=5)
League representatives and Individual Members must fill out this form. Leagues and Individuals have their own sections below, but everyone must fill out the top section.

If you have questions please contact membership@rollerderbycanada.ca Thank you for taking the time to fill this out!
EVERYONE SECTION
Everyone must fill out this section
Type of Membership? *
(select one)
League Name OR Individual Member First and Last Name *
League / Individual Contact Email *
What province/territory are you in? *
PAYMENT *
How will you be paying? All payments must be made available within 10 business days of completing this form
LEAGUES ONLY
This section is for League Membership ONLY
League Contact Email #2
Leagues only
League Contact Phone Number
Leagues only
League Webpage Link
Leagues only
League Facebook Link
Leagues only
What types of derby does your league play?
Select as many as required
How many members in your league?
Clear selection
INDIVIDUALS ONLY
This section is for Individual Memberships ONLY
What is your role in Roller Derby?
Select as many as required
Submit
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