Membership Registration Form - Rugby Fives Association

The Rugby Fives Association

Membership Application Form

Membership No.

Only give details in this section that you agree can be published in a membership booklet or similar lists

SURNAME

INITIALS

FORENAME

Preferred name e.g. Jim, Sue, etc.

TELEPHONE:

MOBILE

HOME

HOME ADDRESS

Postcode:

Enables RFA to determine level of subscription

DATE OF BIRTH

and to target certain events, such as U25,

Veterans, Vintage, etc.

Where did you learn your Fives?

DATA PROTECTION: I give my permission for the above details to be stored in a computer for the sole

purposes of the RFA in their capacity of administering and promoting the games of Fives.

Signed:

Date:

Please return this form with your Direct Debit Mandate and Letter of Guarantee to the RFA

General Secretary: Philip Atkinson, The New Stone House, Carlton Road, Turvey, Beds. MK43 8EG

Alternatively send a scan by email to:

email@philip-atkinson.co.uk

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Parent category: Business