Seniors, Veterans and Social Membership Application form

Wednesday, September 08, 2010

Welcome ! Bienvenue ! Wilkommen !

Senior, Veteran and Social Membership Application Form

Application:

New Application
Membership Update

Section:

Senior Member
Social Member

First Name:

Last Name:

Date of Birth:

Select Date

The date format must
be mm/dd/yyyy.

Social Security Number:

Street:

Town:

Post Code:

Phone No:

Mobile No:

E-mail Address:

Nationality:

Date Arrived in Lux:

Select Date

The date must be in the

format mm/dd/yyyy.

Security Code:

For security reasons the code shown

above must be re-entered into 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 No. etc.

Social Security Number, Medical and Licence are required only for playing members

Membership Fees

The level of membership fees for the 2010/11 season are:

Seniors/Vets/Touch: €100

Social: €25

Membership fees should be paid to;

Rugby Club Luxembourg

Bank: BCEE

BIC: BCEELULL

IBAN: LU38 0019 1000 2457 5000

Payment indicator - Subs

Medicals

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

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