Name & Surname:

 

ID:

 

Cell phone:

 

Telephone:

 

Fax:

 

E-mail:

 

Name of school/club where you are coaching:

 

You are a coach or player at a:

High School
Special school
Primary School
Club
Other

 

Gender:

Male
Femal

 

Race:

White
Black
Coloured
Asian
Other

 

Age:

Under 20
20-25
26-30
30-40
40-50
over 50

 

Level of coaching qualification:

 

SARU

Level 1
Level 2
Level 3

 

IRB

Level 1
Level 2
Level 3

 

Are you interested in more training:

Yes
No

 

Achievements (if any):

 

Playing:

 

Coaching:

 

Choose payment option:

Membership R220
Membership plus 1 extra season ticket R440
Membership plus 1 Test ticket R695
Membership plus 2 Test tickets R1 170
Membership plus 1 extra season ticket & 1 Test ticket R915
Membership plus 1 extra season ticket & 2 Test tickets R1390