DELEGATE APPLICATION FORM – SEASON 2012/13
Name:
Address:
Email Address:
(m)
(h)
Telephone:
Occupation:
Course: Play It Safe
Date of Course:
In Touch
You must have attended safeguarding
training before attending an In Touch
course, either RFU or scUK.
24th January 2013
Venue:
Portsmouth Rugby Football Club
X
Which rugby club are you a member of
and do you hold a role there?
Do you have any specific requirements
in relation to your attendance at this
course?
A cheque for £15 payable to Rugby
Payment:
Football Union must accompany this
Play It Safe:
form and be received at least 14 days
prior to the course date.
In Touch:
This course is free to Club Safeguarding
Officers only. Other club officials
wishing to attend are required to pay £15.
I agree to the Rugby Football Union (RFU) retaining personal data which I have
supplied insofar as is necessary for the purpose of administration of the course/s. I
agree that the RFU can provide my name, occupation, rugby club and role within that
club to the tutor prior to the course date.
Signed:
Date:
Please Note: All delegates must be over the age of 18 years.
Please return this form to Alexis Holding, RFU, Rugby House, Twickenham Stadium, 200 Whitton
Road, Twickenham, Middlesex, TW2 7BA Or by email: [email protected]