Dorset &Wilts Society of Rugby Football Union Referees

DORSET & WILTS SOCIETY OF RUGBY UNION REFEREES

Application for membership

Name:

Address:

Post code:

Telephone number: Home: Mobile:

Preferred contact number: home / mobile*

Dorset Wilts Society of RU Referees operate a text facility, whereby the Fixtures Secretary has the ability to send text messages when searching for Referees at short notice – are you happy to receive such text messages? Yes / No *

E-mail address:

Date of Birth:

Club (member or ex-member):

Details of any previous refereeing training or experience/grade:

Date of Referee course attended and level:

RFU GMS ID No:

Are you happy to undertake Exchange Games (ie out of area): Yes / No *

I apply for membership of the Dorset & Wilts Society of RU Referees and agree to the Society holding my membership record on computer and using the data in the administration of the Society.

Signed:

Date:

Completed applications should be returned to the Membership Secretary of the Society, Peter Straughan, 4 Hannams Close, Lytchett Matravers, Poole, Dorset
BH16 6DN. Or by email:

*Delete as applicable Form Revised 2nd June 2016