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*

How much do you intend to pay (separate from this form)?

If you believe you are exempt from paying dues please explain why

Venmo = @bham-rugby
PayPal = bhamrugby@gmail.com
Mail check made out to "Birmingham Rugy" to Birmingham Rugby, P.O. Box 59262, Birmingham, AL 35259

Name

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