First Name

Surname

Address

Date of Birth (DD/MM/YYYY)

Membership Type Membership Type Life member £850 Patron £300 / year Executive Vice President £155 / year Vice President £85 / year

Main contact telephone number for all club related correspondence

Second Contact Number

Email address for club correspondence

Please outline any special dietary requirements

Ethnicity Ethnicity English, Welsh, Scottish, Northern Irish or British Irish Gypsy or Irish Traveller Any other White background White and Black Caribbean White and Black African White and Asian Any other Mixed or Multiple ethnic background Indian Pakistani Bangladeshi Chinese Any other Asian background African Caribbean Any other Black, African or Caribbean background Arab Any other ethnic group Prefer not to say Other

Please indicate whether you prefer a virtual/electronic or paper 'green book' Please indicate whether you prefer a virtual/electronic or paper 'green book' Virtual/Electronic Paper

Please indicate how you intend to pay the subscription fees, Website, Bank Transfer, Cash and Cheque are accepted. Please put the NAME AND MEMBERSHIP TYPE as reference, account details are: Name: Scunthorpe RUFC Acc No: 04825860, Sort code: 77-16-02 Cheques should be made payable to 'Scunthorpe RUFC Ltd. Please indicate how you intend to pay the subscription fees, Website, Bank Transfer, Cash and Cheque are accepted. Please put the NAME AND MEMBERSHIP TYPE as reference, account details are: Name: Scunthorpe RUFC Acc No: 04825860, Sort code: 77-16-02 Cheques should be made payable to 'Scunthorpe RUFC Ltd. Website Cash handed to team manager Cheque Bank Transfer Other

Emergency Contact Name

Relationship to Member

Emergency Contact Phone Number

Emergency Contact Second Phone Number

IMPORTANT INFORMATION IMPORTANT INFORMATION Scunthorpe R.U.F.C. & it’s officials are not under any liability whatsoever for the loss of property, accidents or injuries howsoever caused at Scunthorpe R.U.F.C. or other grounds. Memebrs agree to abide by the RFU Codes of Conduct (These can be found on the notice board outside the Changing Rooms & on the RFU website www.rfu.com) and by the rules of Scunthorpe R.U.F.C. and Heslam Park Club (These can be found in the Green Book) Data protection: Please note your privacy and the security of your personal information is always at the forefront of SRUFC. As a result, and as required by GDPR, we will make it easier for you to find out how we use your information. We collect and process personal data from you when you join and when we carry out annual renewals of your membership, for the purpose of advertising club activities and promotions and we will share some of your data with the RFU. Please read the new Privacy Notice so you are fully aware of your rights and how we use your personal information. You can access the Privacy Notice detail via the RFU website www.englandrugby.com