Club Membership Form
( Please note that this is not an RFU Registration Form )
Firstname:
Lastname:
Nickname:
Address:
Town:
County:
Post Code:
Home Tel:
Work Tel:
Mobile:
eMail:
Preferred Playing Position:
Alternate Playing Position:
Date of Birth:
Employer:
Profession:
Emergency Contact:
Relationship:
Notes / Comments / Medical Condition (asthmatic, etc):
Prior Clubs and Playing Experience
Membership Category:
Mens Rugbyr
Junior Player
Student
Family
Associate
Womens Rugby
Security Code:
The Code:
Enter the code above
Please note, by submitting this form you agree for these details and these only to be held on a computer database. They will not be passed to any other organisation