Blood & Thunder
Roller Derby Training Camp
Skater Application

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 you receive confirmation from Blood & Thunder. 

Real Name: 

Skate Name:

Address:

Phone number:

E-mail:

League affiliation:

Is your league:  
- Banked track	
- Flat track

USARS #:

How many years have you been doing derby?

How would you rank your skating abilities?
- Beginner	   
- Intermediate	   
- Advanced

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

Would you need accommodations?		

If “yes,” would you prefer:		
- hotel/motel	   
- youth hostel	
- floorspace

Are you a:		
- meat-eater		
- vegetarian		
- vegan

T-shirt size:		
Womens       
- Small 
- Medium     
- Large	 
- XL	 
- XXL

Mens       
- Small 
- Medium     
- Large	 
- XL	 
- XXL

Registration fee:	
$250.00 U.S.

Method of payment 
Pay only after you’ve submitted your registration form and received confirmation.

Check or money order:
Make out to Black Graves Media, and mail to:
Blood & Thunder
c/o Dale Rio
10644 2nd Avenue S.W.
Seattle, Washington 98146

Credit card: 
Go to www.viaderby.com’s Bootique, select “events,”
Click on National Derby Training Camp, and pay for your registration there.

Paypal:
Make your payment to: orders@bloodandthundermag.com
-add $20.00 to cover Paypal’s processing fee.

*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
c/o Dale Rio
10644 2nd Avenue S.W.
Seattle, Washington 98146