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New Member Pre-Registration
Hello thank you for showing interest in Springfield Roller Derby!
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Full Name
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Date of Birth
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Email
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Phone Number
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If you have a Facebook, what is your handle? If this doesn’t apply NA
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I am interested in being a:
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Skater
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Game Day Volunteer
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Do you have any roller skating experience? (It is ok if you do not)
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Practices are typically Tuesdays and Thursdays from 6:30pm-9:30pm. If there is enough new skater interest there would be an opportunity for a different night. What night(s) would work for you?
Sunday
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Wednesday
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Saturday
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