Tournament Matchup Submission Single Game MatchupBy submitting the information below, I, as an, authorized representative of the host league, am requesting the MRDA Games Committee to review the information provided and confirm this game for MRDA sanctioning. Please note: you will need to submit this form for each sanctioned game.Tournament Name (if applicable)-- Select One --Tournament Not ListedAMRD National Championships 2019April AngstBattle of Bunker HillBig-OBrewhahaC-CupEast Coast Derby ExtravaganzaMRDA ChampsMRDA PlayoffsMohawk Valley CupSibling RivalrySilver City CupWheels of SteelRepresentative Name*Representative Email* Event Date* Date Format: MM slash DD slash YYYY Home Team Name-- Select One --Atlanta Men’s Roller DerbyAustin AnarchyBarrow InfernosBototos BandidosBridgetown Roller DerbyBrisbane City RollersCapital City HooligansCapital District Trauma AuthorityCarolina WreckingballsCasco Bay Roller DerbyChicago Bruise BrothersChinook City Roller DerbyCleveland Men’s Roller DerbyCollision Roller DerbyCrash Test BrummiesD.H.R. Men’s Roller DerbyDenver Ground ControlDerby Club le Cres Lattes MontpellierDetroit Men’s Roller DerbyFlour City Roller DerbyGlasgow Men’s Roller DerbyGolden State HeatGranite City BrawlersHarm City Men’s DerbyHelsinki Coast Quads Roller DerbyHouston Men’s Roller DerbyKansas City SlaughterKent Men’s Roller DerbyLane County ConcussionLes Nordiks de TouraineLight City DerbyLincolnshire Rolling ThunderMadRiders Men’s Roller DerbyMagic City MisfitsManchester Roller DerbyManneken BeastsMass MaelstromMen’s Roller Derby JapanMohawk Valley Roller DerbyMontreal Men’s Roller DerbyNew Orleans Brass Roller DerbyNorth Wales Roller DerbyOrcet Roller DerbyPanam SquadPhiladelphia HooligansPittsburgh Blue StreaksPuget Sound Outcast DerbyRace City RebelsRoller Derby ToulouseSaint Louis GatekeepersSan Diego AftershocksSouthern DiscomfortSydney City SMASHTampa Bay Men’s Roller DerbyTampere Rollin’ BrosTexas Men’s Roller DerbyThe Inhuman LeagueToronto Men’s Roller DerbyTwin Cities Roller DerbyTyne and Fear Roller DerbyVancouver MurderVarsity Derby LeagueVictoria Men’s Roller DerbyWheels of MayhemWisconsin United Roller DerbyHome Team RepresentativeHome Team Representative's Email Away Team Name-- Select One --Atlanta Men’s Roller DerbyAustin AnarchyBarrow InfernosBototos BandidosBridgetown Roller DerbyBrisbane City RollersCapital City HooligansCapital District Trauma AuthorityCarolina WreckingballsCasco Bay Roller DerbyChicago Bruise BrothersChinook City Roller DerbyCleveland Men’s Roller DerbyCollision Roller DerbyCrash Test BrummiesD.H.R. Men’s Roller DerbyDenver Ground ControlDerby Club le Cres Lattes MontpellierDetroit Men’s Roller DerbyFlour City Roller DerbyGlasgow Men’s Roller DerbyGolden State HeatGranite City BrawlersHarm City Men’s DerbyHelsinki Coast Quads Roller DerbyHouston Men’s Roller DerbyKansas City SlaughterKent Men’s Roller DerbyLane County ConcussionLes Nordiks de TouraineLight City DerbyLincolnshire Rolling ThunderMadRiders Men’s Roller DerbyMagic City MisfitsManchester Roller DerbyManneken BeastsMass MaelstromMen’s Roller Derby JapanMohawk Valley Roller DerbyMontreal Men’s Roller DerbyNew Orleans Brass Roller DerbyNorth Wales Roller DerbyOrcet Roller DerbyPanam SquadPhiladelphia HooligansPittsburgh Blue StreaksPuget Sound Outcast DerbyRace City RebelsRoller Derby ToulouseSaint Louis GatekeepersSan Diego AftershocksSouthern DiscomfortSydney City SMASHTampa Bay Men’s Roller DerbyTampere Rollin’ BrosTexas Men’s Roller DerbyThe Inhuman LeagueToronto Men’s Roller DerbyTwin Cities Roller DerbyTyne and Fear Roller DerbyVancouver MurderVarsity Derby LeagueVictoria Men’s Roller DerbyWheels of MayhemWisconsin United Roller DerbyAway Team RepresentativeAway Teams Representative's Email Venue Name*Street Address*Street Address 2City*CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweState*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCanadian Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonZip CodeOther Venue InformationFurther InfoAt the completion of the game, the following steps must be taken for this game to count towards rankings:IGRF formThe signed IGRF form can be uploaded on the score submission form, or be emailed to [email protected] within 2 weeks of the game date.Completed Stats BookThe completed stats book can be submitted on the score submission form, or be emailed to [email protected] within 2 weeks of the game date and within 4 weeks of a multi-game event.VerificationBy submitting the enclosed information I am verifying that I have read and understand the steps needed for sanctioning. I also verify that the above games will be played by the most recent MRDA rule-set and the most recent Safety Protocols will be followed.Captcha