Omaha Roller Derby Mistletoe Stop Mania 2023 Junior Skater Registration
Date: December 9th, 2023
Time: 10 am - 6 pm or done
Event Address: Schenzel Community Center (2220 N 20th St, Omaha, NE 68110) 

Skater Registration Fee: $5 per skater
Payment Options: PayPal to ord.finance1@gmail.com OR Venmo to @Omaha-Derby OR cash or check on game day

***Bring proof of USARS/WFTDA insurance

Mixer details: This is a co-ed junior level 3 mixer. There will be one, 30-minute game played by the clock.

Contact us if you have any questions: omaharollerderby@gmail.com
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Legal Name
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Email (Please include parents name & parents email address)
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Date of birth
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MM
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DD
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YYYY
WFTDA/USARS Insurance # (Please indicate if you have different skater insurance, which one)
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Derby Name
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Derby Number
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Your Skating League
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Blocker/Jammer/Both
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What color shirt/s do you have (must have six inch number on the back)*
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How many years have you been skating?
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Payment Options
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