Birmingham Vulcans Rugby Club

Name

First Last

Email

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*

Type of Payment

One Time Payment

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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

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Partial Payment

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Total

$0.00

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Membership

One Time Payment

Monthly Payment

Partial Payment