Personal Information
Legal Name *
Your answer
Derby Name *
Your answer
Pronouns
Your answer
Desired Jersey Number
Not guaranteed, if a current skater already has this number.
Your answer
What kind of insurance do you have? *
Please check all that apply.
Required
If you stated WFTDA or USARS in the above question, please enter your policy number.
Your answer
Email address *
Your answer
Phone Number *
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Desired Transfer Date
Approximate is fine.
Your answer
Will you reside in Columbus, or will you be commuting from another location?
Your answer
Date of Birth *
Your answer
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