Surrey Senior Men County Player Registration Please complete all required fields! Your Details These details are for you, the Player which will be used by the County administrators. First Name(*) Invalid Input Last Name(*) Invalid Input Rugby Club Invalid Input Club Coach Invalid Input Your RFU Registration Number Invalid Input About Your Rugby Please tell us your first and second playing position preferences. 1st Preferred Position(*) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Invalid Input 2nd Preference(*) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Invalid Input Email Address(*) Invalid Input Current Address 1(*) Invalid Input Address 2 Invalid Input Town / City(*) Invalid Input Post Code(*) Invalid Input Home Tel. No. Invalid Input Mobile Tel. No.(*) Invalid Input Town of Birth(*) Invalid Input Gender(*) ...MaleFemale Invalid Input Date of Birth - you must be over 18 years of age(*) ... Invalid Input Emergency Contact Name(*) Invalid Input Emergency Contact - Relationship to Player Invalid Input Emergency No(*) Invalid Input Your Medical History(*) Please enter here ALL relevant details OR type NONE Invalid Input The Surrey Senior Men's County Programme Training and Assessment Training and assessment will take place on 3 dates in April, you are welcome to attend as many of the sessions as you wish. Wednesday 3rd April 2024, Wednesday 17th April 2024 and Wednesday 24th April 2024 at Wimbledon RFC. Please arrive at 6.30pm, the session will begin promptly at 7.00pm. If you cannot attend any of the days then choose 'I can't make any date' and we will contact you with a later alternative date that is yet to be arranged. Attendance confirmation(*) Yes, I will be there on 17/04/2024Yes, I will be there on 24/04/2024Yes, I will be there on 01/05/2024Yes, I will be there on all 3 datesI can't make any of the datesI am currently injured Invalid Input Invalid Input Submit Submit my Application Reset my Form