Application form for Junior membership of Rugby Club Luxembourg

Wednesday, September 08, 2010

Welcome ! Bienvenue ! Wilkommen !

Junior Membership Application Form

New Application / Membership Update:

New
Update

Please tell us who your Parent or Guardian is.

Parent or Guardian Name:

Junior's First Name:

Junior's Last Name:

Junior's Date of Birth:

Select Date

The date must be in the
format mm/dd/yyyy

We need to have your Social Security Number for insurance purposes

Junior's Social Security Number:

Junior's Nationality:

Email Address:

Please enter your street and house number

Address line 1:

City:

Postal Code:

Home Phone No.:

Mobile Phone No:

Junior Group:

Captcha Image (Security Code):

For security reasons, the code
shown must be re-entered in the
field available.

Submit

RCL Use of Information

RCL will only use the personal information that you provide 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.

Instructions for completing the Form

Social Security Number, etc.

Social Security numbers, a medical certificate and licences are required only for playing members

Membership fee

The membership fees for junior members for the season 2009/2010 are as follows:

Age	Annual Subscription
U7	€50
U9 / U11 / U13	€75

Membership fees should be paid to:

Rugby Club Luxembourg

Bank: BCEE

BIC: BCEELULL

IBAN: LU38 0019 1000 2457 5000

Mention "Junior Subs" + Name +Year in the comment section.

Medical Check and Certificate

All children playing must complete a medical check at the INS. Once completed the INS will send a certificate to RCL to confirm the child is certified to play. The INS can be contacted as follows:

Institut National des Sports, 66 Rue de Tréves, Cents - Tel: 2478 3422

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