WSOR website - http://warwickref.com
Entry Level Referee Award (ELRA)
Candidate Application Form - Individual
Please complete all sections in BLOCK CAPITALS
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First name |
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Surname |
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Gender |
M/ F |
Date of Birth |
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Age (if 18 or under) You must be aged at least 14 to attend an ELRA course |
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Full Postal Address |
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Postcode |
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Email Address (please print clearly as this will be used to confirm course) |
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Contact Telephone Number |
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Course Details
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Course applied for Tick one |
ELRA Days 1 and 2 (£50) |
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ELRA Days 1 and 2 with Mini |
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Course date |
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Course fee attached Payable to RFD Ltd. |
£ | |
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Course venue |
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Course Confirmation
Please note that submission of this form constitutes confirmation of your place on your chosen course, unless otherwise notified
You will receive joining instructions by e-mail 5 working days before the course start date
The course will be closed to new applicants 5 working days prior to its start date
Non-Attendance
Your payment will be processed 5 working days before the course start date. If you are unable to attend the course after that date, you will receive no refund; however you will be offered the opportunity to relocate to another course
If you do not notify lindsaypiper@rfu.com of your intention not to attend, you will receive neither a refund nor the opportunity to relocate
Payment
Please return this form, with a cheque made payable to RFD Ltd. or credit/debit card details to
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Payment Type (Please indicate) |
Cheque |
Visa |
Mastercard |
Switch |
Maestro |
Card Number
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Valid From |
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Expiry Date |
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Security No |
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Issue No |
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Ethnicity
I would describe my ethnic origin as:
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Asian British Bangladeshi |
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Indian |
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Other white |
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Asian British Indian |
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Mixed White and Asian |
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Pakistani |
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Asian British Pakistani |
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Mixed White and Black African |
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Prefer not to say |
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Bangladeshi |
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Mixed White and Black Caribbean |
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White British |
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Black African |
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Other |
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Warwickshire Rugby Football Union | C/o Broadstreet RFC, Ivor Preece Field, Rugby Road, Binley Woods, Coventry, CV3 2AY Tel: 02476 541501 | Email: cmcginty@eircom.net VAT Number: 729 7458 78 | | ||||