Register Here for the 2021 Roller Hockey Club Roller Club Registration Name* First Last Birth Date* MM DD YYYY Email* PhoneAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you play ice hockey?* Yes No If yes, what organization and what team did you play on this year? (Example: Waukesha Pee Wee C)If no, would you rate yourself as a beginner or intermediate player?Did you play club last season?* Yes No Jersey Number Preference; Please choose 3 numbers*List three numbers separated by commas.2021 Scheduled Tournaments* Yes April 9-11: NARCh Regional MKE, home rink April 30-May 2: Cinco De Mayo, Des Moines, Iowa May 14-16: Mid West Wars in Chicago May 21-23: MKE Tournament at home rink June 4-6: TORHS Regional Qualifier in Chicago Nationals TORHS Florida: June 25-July 4 By checking the box I confirm that I am able to commit to the National Tournament.CommentInclude any comments or questions regarding the clinic, camp, or program.Liability Waiver* Yes I have read and agree to the liability waiver and terms and conditions.Parent or Legal Guardian*