2014 CRDi West - GO GREEN Database
Welcome to CRDi online membership form.

CRDi will post your info we receive from this online form into your home league database.
Please only fill in this online form ONCE.

DO NOT FILL OUT THIS FORM TWICE.

Membership runs from Jan 1 to Dec 31 each year.

2014 info:
Full membership (prorated) July 1 to Dec 31, 2014 - $30
Effective immediately insurance is $30 Prorated - this will cover you till Dec 31, 2014.
If you want to pay using PAYPAL you must use the button on our website www.crdinfo.ca  Go to the SKATER page and then drop down to PAYPAL.  The $30 charge is $31.25 using PAYPAL (PAYPAL charges a fee to use this service)
or
email transfer CRDiWest@gmail.com $30 - PLEASE include your real name and the league you belong to in the email transfer MESSAGE box available to you when completing the email transfer.

Full membership after being an apprentice to upgrade is $20
If you were an apprentice prior to June 30 and are looking to upgrade, please email us your full name and league you belong to. You do not need to fill this form in again.
Next step is to send payment of $20. If you want to pay using PAYPAL you must use the button on our website www.crdinfo.ca on the SKATER page and then the drop down menu to PAYPAL. The $20 upgrade using PAYPAL is $20.95 (PAYPAL charges a fee to use this service) or email transfer CRDiWest@gmail.com $20 -   - include your name and league in the transfer info

The instructions of HOW TO DO AN EMAIL TRANSFER can be found on www.crdinfo.ca
Go to the SKATER page and then the drop down menu to email money transfer page.
Email transfers can be emailed to: CRDiWest@gmail.com <-----make sure you spell the email address right!

The security question to ask is: What is the best sport
The answer is: rollerderby
If your bank requires a number be added to the answer make it rollerderby2014.


PLEASE add in the email comment section of email transfer payment your REAL name AND the league you belong to.

CRDi does NOT accept  Hyperwallet OR personal cheques from skaters.

PAYPAL - please read
If you send us PAYPAL without the service fee we will not accept it and refund you immediately! Please note that when we refund you when you send the incorrect amount PAYPAL now charges a reversal fee!

We accept email bank transfers, money orders or payment from your LEAGUE if they offer that option - not all leagues offer this.

Money Orders can be mailed to:
CRDi
#200, 33 Blackfoot Road,
Sherwood Park, Alberta
T8A 4W5

Reminder: You will be removed after 15 days and not covered to skate if payment is not received.

Please press SUBMIT at the end of this form. You should receive this response:

"2014 WEST CRDi Membership Form Database
Your response has been recorded."


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Province you live in
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First Name *
Legal name - no nicknames - must match your DL or passport - you are responsible for spelling your name correct here.
Last Name *
Legal name - no nicknames - must match your DL or passport - you are responsible for spelling your name correct here.
Derby Name
If you do not have one skip this question. Please note we do not register derby names.
Address *
City *
Postal Code
Day Born *
Month Born *
Year Born *
League Name *
Health Care Number
It is mandatory as part of our accident insurance that you have provincial health care. CRDi must submit the number to the provider. If you do not have the number on hand you must provide it within 30 days.
Province Health Care Number Issued *
Please mark what Province your health care card was issued
Your email address
We need your email address to email you your CRDi membership number once payment is received.
Type of Insurance you need *
If you are upgrading you do not need to fill in form again - just email me at crdiwest@gmail.com and tell me you need to upgrade
Paying Via: *
When paying via email transfer, Email: CRDiWest@gmail.com.  Security question to ask is: What is the best sport. Answer: "Rollerderby"    PLEASE put in the email transfer comments area your REAL name and league you belong to.
Please read the below statement and print full name in space given below. *
Waiver/Release: I, hereby, do affirm the above to be correct and truthful and hereby make application to Canadian Roller Derby Insurance, CRDI, for insurance to play the sport of Roller Derby.  I agree to abide by the policies of CRDI and upon registration, I hereby waive and release CRDI, The Roller Derby Association of Canada, RDAC, its directors, officers, employees and representatives from and against all actions, demands, costs and expenses in respect to death, injury, loss or damage to my person or property, howsoever caused.  This Waiver/Release shall be binding upon me, my heirs, executors and administrators.  I acknowledge that I have read this document and have had an opportunity to obtain an explanation as to its contents.
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