Membership

"*" indicates required fields

Name

First Last

Nickname

Committee

Which committee would you like to be on or are already on

T-Shirt Size

Phone

Emergency Contact

First Last

Emergency Contact Phone #

First Year with Vulcans

View the Liability Waiver

Liability Waiver*

I have read and agree to the Liability Waiver

Signature*

Note: If the payment options below don't work, exit and pay via PayPal (bhamrugby@gmail.com) or Venmo (@bham-rugby) on your own please.

Type of Payment

One Time Payment

Select Payment Amount

Payment Type

Only select "Check or Cash" if you have already paid by check or cash. If you have not, your account will be deleted and you will have to start again.

Amount Paid by Cash or Check

Have you already paid by Cash or Check

I promise I have already paid by cash or check

Who did you give the Cash or Check to?*

Date Paid Cash or Check

Why are You Exempt?

Monthly Payment

Monthly Payment option is spread out over 5 months. Rookies: $12/month Veterans: $25/month

Select Monthly Payment

Partial Payment

Enter the amount you would like to pay

Total

Comments

This field is for validation purposes and should be left unchanged.