St Helens RLRS Membership Form

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Please complete the following form with your latest information. If required Membership Subscription Fees can be paid via bank transfer to the Society Barclays bank account. Please make payments out to 'St Helens Rugby League Referees Society' - Sort Code is 20-74-45 and the Account Number is 30854875. ENTER YOUR NAME AS THE PAYMENT REFERENCE. (Full = £35 / Young = £17.50 / Associate = £26.25).

Forename *

Surname *

DOB *

YYYY

Address *

Please include address and postcode

Email Address *

Mobile Number *

Membership Status *

Young Member = Aged 12-17. Full Member = Age 18 plus. (Age on 02/02/22)

Young Member

Full Member

Life Member

Honorary Member

Probationary Member

Associate Member

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