2019 Clinic Registration
Registering early saves time, doesn't commit you to anything, and helps us out a lot!
Last name? *
Your answer
First name? *
Your answer
Derby name? (If you have one)
Your answer
Pronouns:
Your answer
Age: *
Bring your ID with you!
Your answer
email address *
Your answer
phone number *
Your answer
Primary health insurance company: *
Bring your card with you! Can't skate without it!
Your answer
Emergency contact name: *
Your answer
Emergency contact phone: *
Your answer
Do you plan to try out as a SKATER for North Star Roller Derby? *
Required
Do you plan to try out as an OFFICIAL with North Star Roller Derby? *
Required
How did you hear about recruiting clinics? *
Required
Have you skated in organized roller derby leagues? *
Select all groups that you have participated in
Required
Anything else you'd like us to know?
Your answer
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