REGISTRATION

   KERN RUGBY REGISTRATION

CONTACT INFO
  • FIRST NAME:
  • LAST NAME:
  • BIRTH DATE:
  • ADDRESS:
  • CITY:
  • ZIP CODE:
  • CELL PHONE:
  • EMAIL ADDRESS:
PLAYER PROFILE
  • HEIGHT:
  • WEIGHT:
  • AGE:
  • PREVIOUS RUGBY EXPERIENCE:
     YES  NO
  • # OF SEASONS PLAYED
  • PREFERRED POSITION:
  • BACKUP POSITION:
ADMIN
  • ARE YOU WILLING TO SUPPORT THE CLUB IN ANY OF THE FOLLOWING AREAS:  Field Setup
     Fund Raising
     Marketing
     Any Other
  • DO YOU NEED ASSISTANCE WITH DUES:
     YES  NO
    IF YES, PLEASE PROVIDE JUSTIFICATION REQUEST BELOW:
  • ARE YOU PLANNING ON PAYING DUES IN FULL OR NEED A PAYMENT PLAN:
     IN FULL  PAYMENT PLAN
  • HAVE YOU REGISTERED THROUGH USA RUGBY:
     YES  NO
  • Captcha
  • * PLEASE NOT THAT ALL PLAYERS ARE REQUIRED TO REGISTER BEFORE OCTOBER 10TH.