Please provide the name (12 characters MAX) that you want displayed on your Name Tag*

Please provide the name (12 characters MAX) that you want to be displayed on the back of your PlayDate T-Shirt.*

Please provide the age that you WILL BE IN AUGUST, to be displayed on the back of your PlayDate T-Shirt*

Please select your T- shirt size (Moisture wicking T-shirt - may run slightly larger than Ladies cut T -shirts; same T-shirts as the white Logo and Orlando Pop-Up T-shirts)*

Which SubClub meetup do you primarily attend? Please enter your City AND State.*

Please select your SubClub's Region*

Please indicate your role with 40+ Double Dutch Club by selecting the appropriate box or boxes below (check all that apply).*

I UNDERSTAND THAT MY PERSONALIZED, PLAYDATE T-SHIRT WILL BE MAILED TO THE ADDRESS THAT I PROVIDE IN THE NEXT 5 STEPS. I CONFIRM THAT THE MAILING ADDRESS THAT I ENTER IS ACCURATE (INCLUDING ANY UNIT, APT OR SUITE NUMBER, IF APPLICABLE), AS THIS ADDRESS WILL BE USED FOR SHIPPING MY PLAYDATE T-SHIRT.*

Street Address - Please enter your Street Number and Street Name ONLY (e.g., 123 Main Street)*

Unit/Apt/Suite Number (if applicable)

City or Town*

State*

Zip Code*