Instructions:

Please fill out this registration form and e-mail to:
trainingcamp@bloodandthundermag.com
or snail mail to the address below.
DO NOT submit payment until after you have submitted your registration form.

Real Name:

Skate Name:

Address:

Phone number:

E-mail:

League affiliation:

Is your league:
Banked track       Flat track

USARS #:

How would you rank your derby skills, on a national level?
Beginner       Intermediate       Advanced

Are you interested in taking part in Saturday night’s banked track bout?

T-shirt size:
Men’s       Women’s

Small       Medium      Large       XL      XXL

Registration fee:
$250.00 U.S.

Method of payment:
Check or money order:
Make out to Black Graves Media, and mail to:
Blood & Thunder
P.O. Box 3452
Seattle, Washington 98114

Credit card:
Go to www.viaderby.com and purchase your ticket. Click here to access the page.

Paypal: Make your payment via paypal by going to the training camp main page and selecting paypal.

* Payment must be received within 30 days of confirmation, or your name will get bumped to the bottom of the list.

If you’re snail mailing your registration, send it to:

Blood & Thunder
P.O. Box 3452

Seattle, Washington
98114