Confluence Crush Roller Derby presents The Merry Mash-Up - Krampus vs. Kringle
Event Date & Time: December 16, 2017 - 10am - 7pm
Event Address: St. Clair County Center, 1550 E State Route 15, Belleville, IL 62221
Contact us at
League Affiliation(s) (If you are unaffiliated, please indicate that here).
What insurance do you have? (If insurance info is not provided your registration will not be accepted).
Adult A Team (have participated competitively in 5+ sanctioned bouts)
Adult B Team (have participated competitively in 5+ non-sanctioned bouts)
Adult C Team/Rec skater (participate in practice regularly and have scrimmaged at least 4 times)
Junior JRDA Level 2
Junior JRDA Level 3
***YOU MUST REGISTER BY 12/3 AT 2PM IN ORDER TO HAVE YOUR NUMBERS PRINTED ON YOUR SHIRTS. IF YOU REGISTER AFTER THAT DATE YOUR SHIRTS WILL NOT COME WITH YOUR NUMBER PRINTED ON THEM**
If you are purchasing t-shirts, what size do you want?
If you are purchasing only 1 shirt, what color do you want?
Upon completion of this registration form please send your registration fee via PayPal (send funds to friends & family) to
or pay with a credit card via our website at
I understand that I must send payment via PayPal or pay on the website to complete my registration.
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