Membership Form

Membership Cost

Seniors - €100 (1st & 2nd team & playing Vets)
Seniors - €50 (Student outside Luxembourg)
Juniors - €50 (Under 7 Only)
Juniors - €75 (Under 9s, 11s, 13s, 15s)
Juniors - €100 (Under 17s, 19s)
Family - €125 (Any children Under 17 + 1 Senior Member)
Social - €25
Touch Rugby - €50

Payment

Payments are to the below account.
BIC: BCEELULL
IBAN: LU38 0019 1000 2457 5000

AFTER payment please make sure you fill in the membership form below and complete all appropriate fields.

Personal informations

ADULT First name: *

ADULT Last name: *

Nationality: *

Email address: *

Telephone Number 1: *

Telephone number 2:

Address: *

Town: *

Postcode: *

Type of membership

Type: *

Junior membership

Family membership

Senior membership

Social membership

Touch membership

Junior

Membership Prices:
€50 Under 7s Only
€75 Under 9s, 11s, 13s, 15s
€100 Under 17s

Child first name:

Child last name:

Social security number:

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Nationality:

Age group for New season:

Under 7's

Under 9's

Under 11's

Under 13's

Under 15's

Under 17's

Family

Family Membership covers any children Under 18 and one Senior/Touch/Vets Player.

Adult

Adult Type:

Senior

Social

Touch

Social security number:

Date of birth:

Year1950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Child 1

Child first name:

Child last name:

Social security number:

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Nationality:

Age group for New season:

Under 7's

Under 9's

Under 11's

Under 13's

Under 15's

Under 17's

Child 2

Child first name:

Child last name:

Social security number:

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Nationality:

Age group for New season:

Under 7's

Under 9's

Under 11's

Under 13's

Under 15's

Under 17's

Child 3

Child first name:

Child last name:

Social security number:

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Nationality:

Age group for New season:

Under 7's

Under 9's

Under 11's

Under 13's

Under 15's

Under 17's

Child 4

Child first name:

Child last name:

Social security number:

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Nationality:

Age group for New season:

Under 7's

Under 9's

Under 11's

Under 13's

Under 15's

Under 17's

Child 5

Child first name:

Child last name:

Social security number:

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Nationality:

Age group for New season:

Under 7's

Under 9's

Under 11's

Under 13's

Under 15's

Under 17's

Senior

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Social security number:

Arrival in Luxembourg: YYYY/MM/DD

Touch

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Social security number:

Arrival in Luxembourg:

Social

Date of birth:

Year20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Social security number:

Arrival in Luxembourg:

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