Derby Fest 2019 Skater Registration
Thank you for registering for a regulation mixer at NJRD's Derby Fest on November 30, 2019. Please complete the following form to register for the event. The cost of registration is $20 per game, which includes a t-shirt and entry to the event. Derby Fest will run from approximately 11:30am until 10pm with 3 adult mixers.


If you have any questions, please send an email to newjerseyrollerderby@gmail.com.
Email address *
Real Name (First and Last) *
Your answer
League Affiliation: *
Your answer
Skater Name: *
Your answer
Skater Number: *
Your answer
WFTDA Insurance Number (or other insurance if non-WFTDA): *
Your answer
Emergency Contact Name and Number: *
Your answer
Shirt size (unisex sizing)? *
Mixer Themes [ALL MIXERS CURRENTLY HAVE WAITLISTS]
If you register for any of the following mixers, you will be placed on the waitlist. If a spot on a roster opens up, you will be notified. Skaters will be placed on the waitlist in the order that they registered. Being placed on the waitlist does not guarantee a spot to skate.

Please choose from the following mixer themes and teams- you may register for more than one non-rookie mixer. NJRD may not be able to accommodate all team requests (we'll try our best). If you register for more than one mixer, you must pay for $20 for each game you register for.
1. WAITLIST: Rookie mixer- 1:30pm-3:30pm (must have played in less than 5 bouts and passed minimum skills)
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2. WFTDA Mixer: Order of Phoenix vs. Death Eaters, 5:30-7:30 REGISTRATION IS CLOSED [FULL]
Sorry!
3. Co-ed mixer- 7:30pm-9:30pm REGISTRATION IS CLOSED [Full]
Sorry!
A copy of your responses will be emailed to the address you provided.
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