WORTHING RUGBY FOOTBALL CLUB MEMBERSHIP FORM 2009/2010 SEASON (From 1st September 2009 to 31st August 2010) MEMBERSHIP CATEGORY: (See overleaf and tick on box) LIFE MEMBER YOUTH/STUDENT MEMBER SOCIAL RENEWAL SENIOR PLAYER FAMILY MEMBER NEW MEMBER MEMBERSHIP DETAILS: FULL NAME: ______________________________ _________ DOB ______________________________ ADDRESS: ___________________________________________________________________________ ___________________________ ______________________ POSTCODE: ________________________ HOME TEL: ____________________________ MOBILE: ______________________________________ WORK TEL ____________________ OCCUPATION __________________________________________ E-MAIL ____________________________________ PARTNERS NAME ___________________________ Please indicate if you wish to receive Club Membership communications in future by email. YES/NO Please indicate if you are agreeable to us passing your name & address to our Sponsors AGREE/NO FOR SENIOR & FAMILY MEMBERS Playing Child’s name DOB SEX M/F SCHOOL/COLLEGE SCHOOL (U6 – U16’s only) YEAR 1. 2. ADDITIONAL PLAYING CHILDREN @ £10 EACH 3. 4. 5. FOR YOUTH & STUDENT MEMBERS PARENT/CARERS NAME __________________________________ MOBILE________________________ COLLEGE/UNIVERSITY___________________________________ NEW MEMBERS PROPOSER ___________________________ (WRFC Member) SIGNED ___________________________ SECONDER ______________________ (WRFC Committee Member) SIGNED _______________________ FOR ALL MEMBERS – MEDICAL INFORMATION – WRFC should be aware of any medical conditions – please attach to this form. PAYMENT DETAILS CASH CHEQUE CREDIT/DEBIT CARD DIRECT DEBIT (on request) CARD HOLDER _______________________________________ START DATE ______________________ CARD NUMBER ________________________________________ EXPIRY DATE ____________________ ISSUE NUMBER _______ AUTHORISING SIGNATURE _________________________________ Please return to the Membership Secretary, Worthing RFC, The Rugby Park, Roundstone Lane, Angmering, West Sussex, BN16 4AX. SIGNED ___________________________________ DATED ___________________________________ CATEGORIES OF MEMBERSHIP Social Member (For non players) A Social member shall be entitled to use the facilities of the club but not to participate as a player in the club’s organised rugby activities Subscription for year 2009/10 – £70 Youth and Student Member (For Under 17s to U18s and those in full time education) For players between the ages of 16 and 19 on 1st September 2009 and players enrolled as a full time student of a further education establishment during the 2009-10 academic year. Youth & Student members may participate as a player in the club’s Youth and Senior rugby activities in accordance with RFU regulations. Subscription for year 2009/10 – £70 Family Member (For Under 6 to Under 16 players and their Parents/Carers/Guardians) A Family member and his or her partner and children, shall be entitled to use the facilities of the club. Two of the member’s children under the age of 16 on 1st September 2009, shall be entitled to participate as players in the club’s youth rugby activities between the ages of U6 to U16. Subscription for year 2009/10 – £140 (£130 if paid IN FULL by 30th September 2009) Additional playing children - £10 each Senior Player (For those players over 19 on 1/09/09 or not in full time education) A senior player and his or her partner and children, shall be entitled to use the facilities of the club. The member but not the member’s partner shall be entitled to participate as a player in the club’s senior rugby activities. Two of the member’s children under the age of 16 on 1st September 2009, shall be entitled to participate as a players in the club’s youth rugby activities between the ages of U6 to U16. Subscription for year 2009/10 – £280 (£260 if paid IN FULL by 30th September 2009 Additional playing children - £10 each Life member A life membership conveys for life the entitlements of a senior player as set out above Subscription for year 2009/10 – £2,000 PAYMENT Membership fees are due annually in advance on 1st September. They can be paid by cash or cheque. To assist Senior Players/Family members wishing to spread their payment, the Club may accept payment by Credit/Debit card or by Direct Debit. Application forms can be obtained on request from the Club’s Office. The club reserves the right to charge an administration fee for late payment of renewal subscriptions at the following rates if not received; By the 1st November - £10 By 1st December - £15 From 1st January 20010 - £20 NOTES Players who are members enjoy the benefit of the Club’s insurance cover with the RFU in respect of death and permanent disability arising from rugby training or playing, subject to certain limits. There is no loss of earnings cover and members are advised to seek additional cover by their own arrangements if necessary. Further information is available on request. Social, Family, Senior Player and Life Members shall be entitled to attend and to vote at the Club’s Annual General Meeting or any other Special General Meeting. Only one vote per member is permitted and partners and named children are not entitled to vote The rights of membership are a privilege which may be withdrawn by the Club’s Management Committee in the event of any disciplinary action being brought against a member.