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Name

Cell Phone

Can we contact you about class via text?

• Yes
• No

Email *

What city do you live in?

Are you at least 18 yrs old?

• Yes
• No

What would you like to get out of this class. Or how can we help you get to your roller skating goals and aspirations.

Once your have mastered beginner - advanced basics what kind of roller skating discipline would you like to learn.

• Recreational Skating at Roller rink & Outdoors
• Roller Derby
• Roller Dance
• Roller Speed Skating
• Roller Figuer Skating

How did you find us?

Phone

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