Missfits Roller Derby Registration
Name (first & last) *
Your answer
Date of Birth *
MM
/
DD
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YYYY
Contact Number *
Your answer
Email Address *
Your answer
Emergency Contact Name & Number *
Your answer
I want to be a: *
Level of Skating *
Have you played roller derby before? *
If yes, which league? *
Your answer
How did you hear about us? *
Do you need to reserve loaner gear? *
Do you have your own skates? *
If you answered no, what size skate do you wear?
Your answer
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