Gem City vs The World Interest Form

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Gem City Roller Derby in Dayton, OH will be hosting an advanced-level scrimmage We invite skaters AND officials available in the region to come play and ref high level derby in our practice space with us!

Details:
DATE AND TIME: SUNDAY, MARCH 3, 11:30a-1:30p (appx)

LOCATION: Dayton, OH (details to come in email)

What is your legal name? *

What is your email address? *

What is your derby name? *

What is your WFTDA insurance number (it will be required to play)? *

What is your league affiliation (if any)? *

How many years have you played or reffed WFTDA-sanctioned games? *

Less than a year

Between one and three years

Three to five years

More than five years

Are you planning to skate or officiate?

Skate

Officiate (skating)

Officiate (non-skating)

Clear selection

What level would you consider your skill in regional play?

(https://stats.wftda.com/rankings/na-northeast) *

I skate in a WFTDA team/at level of WFTDA team in the top quarter of regional play

I skate in a WFTDA team/at level of WFTDA team in top half of regional play

I skate in a WFTDA team/at level of WFTDA team regional play

I plan to officiate / NA

We will be asking for a $5 fee for visiting skaters. Please confirm you have been informed and accept this!

(We will have modes of Paypal or Square payment available; officials will NOT be asked to pay a charge) *

Yes!

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