Cherry City Roller Derby - Membership Application
Thank you for your interest in joining Cherry City Roller Derby! Tell us a little about yourself, answering all questions as completely as possible.

*If you are filling this application out for your child, please make sure you enter your child's information first and then yourself under the guardian section(s). If you have more than one child applying, please complete an application for each child. Thanks!
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Email *
Applicant First Name *
Applicant Last Name *
Applicant preferred name if different than legal first name
Applicant Birthdate *
MM
/
DD
/
YYYY
Preferred Pronouns
Best email address to contact you (or your guardian) - this will be used for initial communication and billing purposes *
Best phone number to contact you (or your guardian) (ex: 5035551212) *
Street Address *
City *
State *
Zip Code *
What type of membership are you applying for? *
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