Full Name (Please Print ……………………………………. D.O.B …../……/…………

Address: …………………………………………………………………………………..

………………………………………………………………… Post Code ……………..

Tel. Home …………………………..….. Business ……………………………………..

Mobile …………………………………… e-mail ……………………………………….

Registration commences at 9.00am, The Course begins at 9.30am and finishes at approximately 4.00pm.

Course Venue to attend – Cross Keys   RFC     Date:

Is it your intention to be actively refereeing if you pass the this Course?:   Yes / No

If so at what Level: Junior / Schools / Youth /  District  (Please circle intention)

Do you intend to attend your local Referees Society Meetings?       Yes / No

Successful Candidates may purchase a Starter Pack @ £30 (If stock is available)
(Jersey, Whistle, Red and Yellow Cards, Law Book, Rugby Pathway Booklet)

PLEASE ENCLOSE CHEQUE FOR £15 WHICH COVERS LUNCH & ADMINISTRATION COSTS TO :-
Welsh Rugby Union
FAO David R Davies
First Floor, Golate House,
101 St Mary Street,
Cardiff.
 CF10 1GE

APPLICATIONS MUST REACH THIS OFFICE NO LATER THAN ONE WEEK PRIOR TO THE COURSE REQUESTED AND CHEQUES MADE PAYABLE TO THE WELSH RUGBY UNION.

Any further information contact David R Davies on 02920 822420 or davidrdavies@wru.co.uk

Disclaimer:
I will not hold the Welsh Rugby Union, it’s Employees or the Welsh Society of Rugby Union Referees, responsible for any loss or injury sustained on the Course.
Signed: .........................................................................  Dated.....................................................................