2020 Smart Rugby Face-2-Face Registration

Smart Rugby Online Registration Tuesday 19th May, 2020 6:00pm-8:30pm approx.

Please complete the form below
Full Name *

First Name Last Name
Rugby Xplorer ID Number
My Rugby ID Number used as Login for Rugby Xplorer
E-mail *
Phone Number *

Area Code Phone Number
Date of Birth *

Day Month Year
Do you identify as Aboriginal or Torres Strait Islander

Yes No
Other Information:
Primary Role *
Region/Association *
Club
Eg; Norths Rugby Union
School
(If you are a school coach)
Have you previously been Smart Rugby certified?

YES NO
Should be Empty:

Smart Rugby Online Registration Tuesday 19th May, 2020 6:00pm-8:30pm approx.