APPLICATION FORM FOR SENIOR MEMBERSHIP NB: active players are not eligible for membership! Date format is dd/mm/yyyy. Surname (required) First name (required) ID number (required) Date of birth (required) Race/Ethnicity (required) Language (required) AfrikaansEnglishXhosaOther Contact number (required) Your Email (required) Confirm Email (required) Postal/Contact address (required) Occupation (required) Next of kin (required) Relationship to kin (required) Contact number of kin (required) BokSmart number Expiry date Have you reffed before? YesNo If yes, where and at what level? AR /INTRO Level YesNo World Rugby Level 1 YesNo How have you been informed of becoming a referee with our society? (required) Are you presently a member of a rugby club and at what level did you play? YesNo If yes, at what level? If yes, name of club? Are you prepared to referee on Sundays? YesNo Are you prepared to referee anywhere in the Western Province? YesNo What is your mode of transport? (eg. public or private) (required) By submitting this form, you certify that the information contained herein is true and correct as well as the following: I hereby undertake to be a devoted and disciplined member of the Society and to subject myself to the Constitution and Bye-laws of the Society as legally amended from time to time. I have read and agree to the above information
