Track Side Medical Staff Form
Please fill out this form if you are interested in being a medic for the WFTDA recognized tournament, K-Town Shakedown, held in Kalamazoo Michigan, on April 24-26, 2020. Our Head Medic, Dee Struction, will contact you if you are selected, and provide you with more information on scheduling. Thank you for your interest in our event!
Full Name
Derby Name (if applicable)
Phone Number
Email Address
Medical Licensure Level (please select the highest level you have achieved)
Clear selection
CPR Expiration Date
Do you want to be placed on our league medical list or only for this single event?
Clear selection
Shirt Size (unisex cotton shirt)
Clear selection
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