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USI Rugby Club Interest Form
Name
*
First
Last
Phone Number
*
Age
*
Email
*
T-shirt Size
*
S
M
L
XL
2XL
3XL
Height
*
5'1"
5'2"
5'3"
5'4"
5'5"
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"
6'
6'1"
6'2"
6'3"
6'4"
6'5"
6'6"
6'7"
Weight
*
in lbs
Level of Experience
*
None
Basic Understanding
Moderate Experience
Very Experienced
Level(s) of Commitment
*
Administrative / Coaching
Practices Only (low)
Practices & Non-League Matches (med)
Practices & League Matches (max)
Position(s) Played
*
Back
Forward
Support
I don't know
How many years of rugby experience (if any)?
*
Are you a student at USI?
*
No
Yes (part-time)
Yes (full-time)
Remember, only full-time USI students are allowed to play in league matches.
If you answered "No," do you plan to attend USI soon?
*
No
Yes (within 6 months)
Yes (within 1 year)
How do you plan to pay for USI & USA Rugby dues?
*
I will pay for myself
My parents will pay
I am willing to raise money
Example
Please provide a recent photo of yourself:
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Max file size: 20MB
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Emergency Contact Person
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First
Last
Emergency Contact Relationship
*
Father, Mother, Spouse, etc
Emergency Phone #
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Comments or Questions
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