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Membership Application Form Season 2014-2015
(Senior Playing Members Only)
Membership Fee:FULL£150:STUDENT £110:
PAY BEFORE 31.8.14 - £10 DISCOUNT
CHEQUEPAYABLE TO:AGSFP RFC
Please sign and return yourchequeASAP. For those joining the Club after this date, please complete and return the form plus cheque within 7 days.
Note:DIRECT DEBIT forms from HMoles (1 installment of £45 7x£15 Installments/5x£22 installments).
a) FORENAME / SURNAME / DOB:b) ADDRESS
Postcode
c) E MAIL
d) TELEPHONE / HOME
BUSINESS
MOBILE
e) Occupation / National Insurance No. (if requested)
f) AGFP Player Last Season: (Y / N) / g) If Not; Which Club:
(Scottish Premier or National League Club or Cup match?)
h) Have you played for any other Home, European or Overseas Club in the last 12 months? (Y/N)
Note: If you have answered ‘Yes’ to either g) or h) you will need clearance from the SRU (and the other Union) before playing for the Club. Please contact Graham Barron (07714 898 849) for further details.
Additional Information for SRU Registration purpose
Eligibility to play for Scotland: / Place of Birth:UK/European Passport holder: Yes / No
If not born in Scotland are you eligible through one of the following: / Parent/Grandparent born in Scotland*
(*Underline which) / Permanent Residency (3 yrs+): Y/N / Have not played Rep. Rugby for any other country:Y/N
Playing Details: / Specify Position(s):
(detail preferred / alternatives as required)
Declaration:
I declare that the above information is correct. In signing this form I agree that the above named player shall be bound by the regulations, bye-laws, general regulations and directives of the International Rugby Board and the bye-laws and resolutions of the Scottish Rugby Union and the rules of the player’s club. I understand that this form, which includes personal data about the above named player for the purposes of the Data Protection Act 1998 (“the Act”), will be kept by Scottish Rugby Union plc (“the SRU”). As well as being held by the SRU, I understand that this data will be processed by the SRU in the following ways: disclosure to medical advisers and other lawful third parties; and disclosure to rugby clubs (including non-affiliates of the SRU), all within the terms of the lawful purposes specified in the SRU’s notification to the Information Commissioner un the Act, and I consent to this processing.
Agreed by: Date//
(Player)
Agreed by: Date//
(Club Official)
Please return this form and your remittance to: Graham Barron, c/o Club centre, 86 Queens Road, Aberdeen