Skate Name and Number Request Form
Woo!!! Time to submit your derby name and number!!! Congratulations! :0D

• Please be advised that your choice of skater name must be approved by our Training Director.
• You may only submit your derby name and number upon passing fresh meat boot camp level two.

For more details concerning uniforms/names/numbers, please see

*Refer to this visual example per WFTDA.*

Name Choice
• Skater names are required to be family friendly. Think "PG" rated.
• Our league does not use Two Evils to register or check for skater names.
• Please refer to SMRD's Contact List to check your name and number for uniqueness.
• You must receive approval from retired or former members before using a similar name or reusing a number.
First Name Choice *
Your answer
Second Name Choice *
Your answer
Third Name Choice *
Your answer
Number Choice
• Maximum of 4 characters, but must contain at least 1 numerical digit (24, 1492)
• May be alphanumeric (ex. 6FT, 6ft), but the letters will not be part of the roster number. Letters can only be in front of or behind the number. (i.e. B33R is actually 33 on the roster, although on the uniform, the "B" and "R" will be surrounding the 33 but at a smaller font.)
• No symbols (ex. <3 will not be acceptable)
• The number 1 has been retired from every roller derby team out of respect.
First Number Choice *
Your answer
Second Number Choice *
Your answer
Third Number Choice *
Your answer
Existing Info
Your Real Name *
First and Last
Your answer
Email Address *
Your answer
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