Auction Registration | The National Birmingham Roller Club

To register for the Auction or to buy items from the store, you need not be a paid club member. But you must be a registered member. Fill out the form below. This is for nonpaying club members.

Name
Username*
PhotoUpload Upload an image you would like to represent you on the website. Please keep it tasteful.
First Name*
Last Name*
Nickname
Contact Info
Home Phone Enter your home phone number
Cell Phone Enter your cell phone number
E-mail*
About Yourself
Biographical Info
- Billing Address
- Country*
- First Name*
- Last Name*
- Company Name
- Address*
- Town / City*
- State / County*
- Postcode / Zip*
- Email Address*
- Phone*
- Ship to a different address?
- Shipping Address
- Country*
- First Name*
- Last Name*
- Company Name
- Address*
- Town / City*
- State / County*
- Postcode / Zip*
Are you a real person*

Register for the Auction

Name

Contact Info

About Yourself

Billing Address

Shipping Address

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