COURSE AWARDS
CANDIDATE FORM
PLEASE COMPLETE USING BLOCK CAPITALS
Tag (£20)...............................................................
RLA (£20)..............................................................
Rugby Ready (£18) ………………………………… X
Front Row (£10)....................................................
Maul & Ruck (£15)...............................................
Continuity in Attack (£15)......................................
Defence (£15).......................................................
The Line Out Game (£15).....................................
Other (please specify)……………………………………………………………………
Cheques should be made payable to “Rugby Football Development Limited (RFDL)
Course venue:_______________________________________________________
Course date :_________________________________________________________
Course tutor :_________________________________________________________
First name___________________________________________________________
Last name___________________________________________________________
Name known by______________________________________________________
D.O.B.______________________________________________________________
Gender Male Female
House number_______________________________________________________
House name_________________________________________________________
Address 1___________________________________________________________
Address 2___________________________________________________________
Town____________________________ County_____________________________
Postcode_______________________ Previous address postcode_______________
Daytime telephone________________________________________
Email address________________________________________________________
Ethnicity
White – British White – Irish
Any other White background Mixed - White or Black African
Mixed - White or Asian Any other mixed background
Chinese Any other
Black or Black British – Caribbean Black or Black British – African
Any other Black background Asian or Asian British – Indian
Asian or Asian British – Pakistan Asian or Asian British – Bangladeshi
Any other Asian background
Disability Yes No
Club name_____________________________________________________________
School ________________________________________________________________
CRB referee (if known)____________________________________________________
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