Registration Data

We hold the following information via the club’s registration system Membermojo

Name:
Title:
Gender:
Date of birth:
Agegroup in Forthcoming Season :
Playing Position:
Previous Club:
RFU Membership Number:
Effective Date of RFU Registration:
School / College Name:
School / College Telephone Number:
School Year from September:
Medical Condition:
Medical Condition – Description:
Name of Doctor:
Name of Surgery:
Location of Surgery (Town):
Doctor /Surgery Telephone Number:
Parent 1 Last Name:
Parent 1 First Name:
Parent 1 Gender:
Mobile number:
Parent 1 Home Telephone Number:
Parent 1 Work Number:
Email:
Address:
Agree to Photography:
Parent 2 Last Name:
Parent 2 First Name:
Parent 2 Gender:
Parent 2 Mobile :
Parent 2 Home Telephone :
Parent 2 E-mail Address:
Parent/Guardian 1
Voting at the PSSC AGM and EGM :
Additional Donation (£):
Donation Instructions:
Member number: