ESSEX COUNTY RUGBY UNION REFEREE’S SOCIETY

APPLICATION FOR MEMBERSHIP

 I wish to apply for membership of the Society and will accept the Rules of the Society as a condition of membership.

 NAME:…………………………………………………………………………….

ADDRESS:………………………………………………………………………….

                         ………………………………………………………………………..

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 POST CODE:…………………                                  DATE OF BIRTH:……………..

 HOME TEL. NO……………….                                BUS. NO…………………..

 MOBILE:……………………             E.MAIL……………………………….

I will be available from (date)…………………….. 

Saturdays:        Yes/No            Sundays:           Yes/No            Mid Week        Yes/No

 Exchanges with other Societies (this may involve long journeys): Yes/No

 I am a member of………………………………………Rugby Club (if applicable)

 Previous experience:…………………………………………………………………..

………………………………………………………………………………………….

 ………………………………………………………………………………………… 

I agree to pay the current annual subscription when probationary membership is approved.

 Signed:…………………………………………..                   Date:………………….