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Monterey Bay Derby Dames by pengxuezhi

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									                       Monterey Bay Derby Dames
                                   GENERAL INTEREST APPLICATION
                              Name

                              Date of Birth

                              Street Address

                              City, State, Zip

                              Home/Cell phone

                              Email

                              Occupation

                              Interested In                       SKATER               REFEREE             NSO
                              please circle
  I found out about the Monterey Bay Derby Dames through:
    Facebook     Flyer/Poster/Article                                A friend. Name:
    TV/Radio     Website:                                            Other:

Why do you want to join MBDD?


How do you want to be involved?


What is your past experience with team sports?


What “off skate” skills and/or qualities do you possess that you see as an asset to MBDD?




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                  &
Agreement & Signature
By submitting this application, I declare that the information provided is valid and accurate. I understand that if my
membership with Monterey Bay Derby Dames is accepted, any false statements, omissions or direct
misinterpretation made by me on this application may result in immediate expulsion from the league. Upon
acceptance into the league, I agree to pay a one time $20 affiliation fee in addition to monthly dues.
Printed Name:
Signature:                                                                    Date:


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