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Welcome to Fullerians RFC

On behalf of the committee of Fullerians RFC, I would like to welcome you and hope you will enjoy both the playing and social aspects of our club.

Your membership fee is needed for the day to day running of the rugby club and the new Clubhouseon-going funding.

If anyone would like to find out more information regarding this please don’t hesitate to contact either me (07977 220501) or Kevin Brind 07900 997690 (Club Chairman)

Jeff Wall

Membership Secretary

Fullerians Senior Membership Application Form 2018-2019

Category / Tick relevant box
Full Playing Member / £250for season
or £24 EVERY month
24 x 12 = £288
Occasional Player / £160 for season
Maximum 10 games. £10 per game thereafter
Prices include shirt money and Social Membership
Student/Apprentice / £40.00 per annum
Social Membership
(includes partner) / £60 per annum
Full Name
Address
Post Code
E-mail address
Date of Birth / ____/____/_____
Home Telephone number
Mobile number
E-mail Address
Emergency contact
Emergency Number
Name,
address,
D.O.B,
e-mail address
of Spouse or Significant Other, to be added as Social Member
Player Occupation / ______

For the Fullerians Business Directory ( Please complete )

Medical Form

Please note that as a rugby club affiliated to the Rugby Football Union our qualified first aiders have attended a 6 hour First Aid for Appointed Persons course as required under Health and Safety legislation. We are able to carry out basic first aid. All incidences of injury or illness will be recorded in the Accident/Incident book. This must be acknowledged and signed by all relevant parties, including yourself.

It is important to note that we can offer immediate first aid ONLY. An ambulance will be called to any emergency but we must stress that it is your responsibility to seek further medical advice in ALL circumstances of injury/illness as underlying medical problems may not be immediately apparent, for example:

•Cuts and grazes may become infected

•Bruising / Soft tissue injury may be concealing a fracture

•Head Injury may worsen some hours after the incident You can consult medical professionals such as:

•Your General Practitioner

•NHS Direct –Telephone Number 0845 4647

Although you are not obliged to, it would also be helpful if you could advise us of any existing medical conditions, allergies, etc that we would need to be aware of when providing first aid treatment. A club representative will contact you to discuss your specific needs. This information will be kept in strict confidence in accordance with the Data Protection Act 1998.

I understand that I am advised to seek qualified medical advice following any accident/incident and that any decision not to do so is mine alone. I have the following medical conditions / allergies: (please detail, including medications, etc)

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

Signature:………………………………………..

Print Name:………………………………………………………..

Date:………………………………….

STANDING ORDER PAYMENTS

Please arrange your monthly standing order with your bank.

Make payments to:-

Account name: Fullerians RFC

Bank: Metro Bank

Account Number: 15607599

Sort Code: 23-05-80

Put YOUR NAME plus Subs as the Reference

Please let Jeff Wall know when you have arranged this.

If you require a Standing Order Mandate to arrange this, please contact Jeff Wall and one will be sent to you.