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Mens Rugby Club Information
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Email
*
Your email
Athlete Name
*
Your answer
Athlete Age
*
Your answer
Athlete D.O.B.
*
MM
/
DD
/
YYYY
Athlete Phone number
Your answer
Athlete Address
*
Your answer
Rugby Experience
*
Beginner, Little to no experience
Intermediate, some experience
Advance, multiple years of experience experience understands the game
Are You Cipped
Yes
No
Clear selection
Have You Paid Your Club Dues?
Yes
No
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Are you interested/need in financial assistance? (I.e. payment plan)
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No
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Emergency Contact Name
*
Your answer
Emergency Contact Number
*
Your answer
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