Social Membership Form

Name *

Email Address *

Phone *

Street Address

City

State/Province

Eircode

Date of Birth *

Day *

Month *

Year *

Term & Conditions of Membership

As a member I/We agree to the following:

To inform the club (team coach/manager) of any relevant medical condition.
To inform the club (team coach/manager) of any injury sustained while playing Rugby within 2 weeks of its occurrence.
Accept responsibility for personal possessions.

I agree

Yes

Yes

I understand that I can withdraw my consent at any time by writing to the Club.

Social Membership €20. Please click the button below to complete your payment.

Credit/Debit Card Details *

Please enter your long card number, expiry Date and security code then click the button below to complete payment.