Print Form Now and then send to the Alumni at the address below.

STUDENT RUGBY LEAGUE ALUMNI

NAME: ...............................................................

DATE OF BIRTH: ...............................................

ADDRESS:......................................................................................................................................

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POST CODE: ...................................

TELEPHONE(S): .............................................................

COLLEGE OR UNIVERSITY STUDIED & YEARS :

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SUBJECT STUDIED & QUALIFICATION:

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PLAYING POSITION(S):

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RL EXPERIENCE:

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RL HONOURS:

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COACHING QUALIFICATIONS:

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CURRENT OCCUPATION/BUSINESS TITLE:

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ALUMNI MEMBER WHO INTRODUCED YOU (if applicable):

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MEMBERSHIP TYPE:               

FULL £20.00 p.a. (Open to all ex-students):

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ASSOCIATE £20.00 p.a. (Open to all):

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STUDENT/1ST YEAR GRADUATE £10.00 p.a.:

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By completing the Standing Order form below with your bank details, administration is far easier. If you wish to pay by cheque, please make it payable to “Student Rugby League Alumni” and return it to the address at the bottom of the page.

STANDING ORDER FORM (FOR BANK USE)

Please commence to pay the Midland Bank PLC, Crowthorne Branch, for the credit of the “Student Rugby League Alumni” until further notice:

ACC. NUMBER:            01118676                      SORT CODE:     40/18/46

THE SUM OF: .................................     (WORDS)          ............................        (FIGURES)

(Remember it’s only £10 per year for students and first year graduates)

BEING AN ANNUAL PAYMENT ON THE DAY RECEIVED AT THE BANK UNTIL FURTHER NOTICE:

1) BANK: ........................................... 

2) BRANCH: ....................................................................

3) BRANCH ADDRESS:

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....................................................................................................................................................................................................................................................................................................................

4) ACCOUNT NAME (YOUR NAME):

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5) ACC. NO: ................................................    

6) SORT CODE: .................................................

7) SIGNATURE: ......................................................     

8) DATE: ................................................