Application for family membership of the Rugby Club Luxembourg

Welcome ! Bienvenue ! Wilkommen !

New Application / Application Update:

NewUpdate

Parent or Guardian First Name:

Parent or Guardian Last Name:

E-mail Address:

Address:

Town:

Post Code:

Please enter a phone number where we can reach you.

Contact Phone Number:

Mobile Phone Number:

Nationality:

First Junior Member

First Name:

Last Name:

Date of Birth:

Select Date

The date must be in the

format mm/dd/yyyy

Playing:

Yes
No

Junior Group:

Social Security No:

Nationality:

Second Junior Member

First Name:

Last Name:

Date of Birth:

Select Date

The date must be in the

format mm/dd/yyyy

Playing:

Yes
No

Junior Group:

Social Security Number:

Nationality:

Third Junior Member

First Name:

Last Name:

Date of Birth:

Select Date

The date must be in the

format mm/dd/yyyy

Playing:

Yes
No

Junior Group:

Social Security Number:

Nationality:

Required Security Code:

For security reasons the code
shown above must be re-entered

into the field available

SUBMIT

RCL will only use the personal information provided by you in the adjacent form for the purpose of membership administration and communicating with its members. You will have access to this data in accordance with Luxembourg data protection legislation.

Social Security Nos., etc.

Social Security Numbers, Medicals and Licence are required only for playing members of your family.

Membership Fees should be paid to:

Rugby Club Luxembourg

Bank: BCEE

BIC: BCEELULL

IBAN: LU38 0019 1000 2457 5000

Payment indicator - Family Subs

Medicals

INS Luxembourg: Institut National des Sports, 66 Route de Tréves, Cents - Tel: 2478 3422.

Medical certificate from family doctor only for Under 7s