Registration Form
Fill out the form carefully for registration
Agent Code
Athlete Name
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
Please Select
Male
Female
N/A
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Parents E-mail (If Under 18)
example@example.com
Parents Mobile Number (If Under 18)
-
Area Code
Phone Number
Which position are you interested in playing ?
Please Select
Prop
Hooker
2nd Row
Back Row
Scrum Half
Fly Half
Centre
Wing
Full Back
Tell us about you School Career, and your Highlights
Back
Next
Tell us about your club playing career, and any highlights
Tell us about yourself? What are you interested in outside of rugby?, what motivates you ?, favourite food, favourite movies etc.
Back
Next
Kit Sizes
Small
Medium
Large
X Large
XX Large
Playing / Training Top
Playing / Training Bottoms
Outdoor Jacket
Polo Shirt
Hoodie
Signature
Any Other Comments / Questions ?
Continue
Continue
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