Missfits Roller Derby Registration
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Name (first & last) *
Date of Birth *
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/
DD
/
YYYY
Contact Number *
Email Address *
Emergency Contact Name & Number *
I want to be a: *
Level of Skating *
Have you played roller derby before? *
If yes, which league? *
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?
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