Youth Regional Trial Form

About You
Title*
First Name*
Last Name*
Address Line 1*
Address Line 2
Town/City*
County*
Postcode*
E-mail*
Home Tel Number
Mobile Tel Number
Date of Birth*

MonthDayYear
Club/University*
Prefered Playing Position 1
Prefered Playing Position 2
Number of Years Playing
Previous Playing History
Region to trial at
Use the dropdown list below to pick your region to trial at, this should be based on the location of your Club or the County you live in.
Region*
Medical Details
List any Allergies
List any medical conditions....
Current Medication
Recent Injuries in last 3 months
Next of Kin/Emergency Contact Information
Relationship to player
First Name
Surname
Home Tel Number
Mobile Tel Number
Ethnicity
Ethnicity group
Disability
Do you consider yourself to be disabled, if yes please indicate using the drop down list below.
Disability
Data Protection
An Opt style has been agreed and subject to your election, if you do or do not wish to receive certain types of data you should tick the appropriate box below; the RFUW may also use such personal data for the following purposes:
Option 1

Yes... I would like to be included in the RFUW electronic mailing list (including email, SMS or multimedia messages) informing me about RFUW Sponsors, their associated companies and their products and services which may be of interest to me.
Option 2

Yes... I would like to be included in the RFUW electronic mailing list (including email, SMS or multimedia messages) informing about RFUW tickets, products, special offers, opportunities and related service which may be of interest to me.
Option 3

Yes... I am happy for my details to be forwarded on to RFUW official sponsors, who may use them now or in the future and to keep you informed by post of their products and services and to compile market research information and statistics.
Click here to read terms and conditions
Terms and Conditions*

I confirm that I have read and accept the terms and conditions.
Should be Empty:

About You

Region to trial at

Medical Details

Next of Kin/Emergency Contact Information

Ethnicity

Disability

Data Protection