Premiership Membership Form 2016/17 – The RPA : The Rugby Players' Association

Premiership Membership 2017/18

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Club *

First Name *

Surname *

Date of Birth *

Nationality *

Address 1 *

Address 2

Town *

Post Code *

Mobile Telephone *

Email *

Agent Name *

Comapany *

Please select your membership level: Please select your payment method:

*If paying by bank transfer please quote your name as a reference and inform us of your payment.

Once your application has been confirmed you will receive an RPA Membership number and card.

Your personal data will be processed in accordance with data protection legislation at all times and to allow you to take full advantage of RPA membership and services.

Signed *

Date *

Please select if you would like to be involved in fundraising activities for Restart Rugby - The Players' Charity

RPA PREMIERSHIP

Membership 2017/18

Premiership Membership 2017/18