WETHERBY RUFC

Application for Membership

Season 2015/2016

We are very pleased to welcome you to Wetherby RUFC.

Personal Details(please print)

Surname / Forename / Date of Birth / Age
Address and postcode / Preferred Position (Playing)
Home Tel: / Mobile Tel: / Occupation:
Name of emergency contact / Emergency contact number:
Medical condition/allergies
E-mail Address(es)

I wish to apply formembership to Wetherby Rugby Club and have completed the personal information as required.I agree to pay the annual membership subscription and match fees if relevant. Please tick relevant:

Playing
£40.00 / Student/U25
£25 / Non Playing
£25 / Vice President £40 / Social
£30

For Playing members only:

I would like to pay my match fees in advance at £75 for the year, I understand that this is a discounted rate and represents a saving of up to 50%.

Discounted match fees for year
£75.00

I enclose payment (cheques made payable to Wetherby RUFC) .

Chq / Cash / Website

By returning this completed form, I agree to the abide by the codes, players’ charter and rules of the club

I understand that I will be kept informed of these activities – for example timings and locations of fixtures and/or training via email and the website

On acceptance of membership, you automatically become a member of Grange Park Sports Club so covered by its insurance (no extra charge). Please tick the following box if you DO NOT wish to become a member of Grange Park Sports Club. 

I will show self-discipline, sportsmanship and respect towards fellow players, opposition and officials at all times to maximiseenjoyment of the game and understand that serious breaches could lead to exclusion from the club. I have received and will adhere to the Wetherby Code of Conduct. This includes after the game and off the premises when I am identifiable as a Wetherby player.

As a player I understand there is a requirement for me to act as duty man from time to time and that there is an expectation to be available for games for all the teams where appropriate.

I hereby give permission for an authorised person to give the immediate necessary medical or surgical treatment as directed by medical authorities.

I am aware that the club provides registered members with only limited insurance cover through affiliation to the RFU. (You are strongly advised to consider additional personal accident cover for your player(s). Should you require more information about this, please refer to the RFU website

I understand that by returning this completed form I consent to the photographing/videoing and publication of images of myself for club promotional material.

Gift Aid Declaration

Please tick this box to make the following gift aid declaration. 

I would like Wetherby Rugby Union Football Club to treat my membership subscription/donation as a Gift Aid donation from this date forward and for the previous four financial periods (if applicable).I confirm I have paid or will pay an amount of income tax and/or capital gains tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify.

Signature / Date

Please hand your form to Ruth McHenery, Phil Hill or Nick Oates complete with relevant fee or forward to:

Ruth McHenery, 158 Prince Rupert Drive, Tockwith. YO26 7PU, queries 07770 236703