Interest Form

USI Rugby Club Interest Form

* Indicates required field

Name *

First

Last

Phone Number *

Age *

Email *

T-shirt Size *

Height *

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

Emergency Contact Person *

First

Last

Emergency Contact Relationship *

Father, Mother, Spouse, etc

Emergency Phone # *

Comments or Questions *

Submit