Join Us! Register with the Fog

POSTED 28 Jan 2008

Fill out the form below to begin the process of becoming an official member of the San Francisco Fog RFC.

* Required field

Contact information

First name: *

Last name: *

Street 1: *

Street 2:

City: *

State: *

Zip/Postal Code: *

Telephone:

E-mail: *

How did you hear about the Fog?:

Please be specific (e.g., "A guy named Joe recruited me at Castro Street Fair," "I saw a flyer at Gold's Gym," "I played touch on the beach last summer," etc.)

Personal information

Date of birth*

Height & weight (e.g., 6'0", 200#): *

Previous rugby experience, if any:

Please be specific, including positions played, how long, and at what level (e.g., "I played prop and hooker for three years with the Springfield Sharks Mens Division III team, and scrumhalf in high school.")

Other sports experience, if any:

USA Rugby CIPP No.:

Provide only if you were a player or coach in 2006-07

Health Insurance Information

Note: All full members are required to have health insurance. If you do not, or if you would prefer to provide this information privately, please contact the club secretary.

Provider:

e.g., Blue Shield of California

Group number:

Member / Policy / Certificate number:

Additional info (if any):

Emergency Contact Information

Note: All full members are required to provide an emergency contact.

Contact name:

Telephone:

Telephone (alternate):

Relationship to you:

Administrative Information

This information is requested to help club resource and activity planning.

Would you be interested in helping out with any of the following areas?:

Rugby operations: equipment, fields, match day prep

Socials, tours, or events

Recruiting, merchandising, or marketing

Fundraising and sponsorships

Other skills that might benefit the club:

This can be anything that might benefit the organization that is not rugby-specific (e.g., graphic design experience, owner of an event space, party planning expertise, etc.)

Dietary restrictions:

None

Vegetarian

Vegan

Gym(s) you belong to:

Fog Bursary:

Please contact me about contributing to the Fog Bursary program, which provides financial assistance to qualified players in need.

Membership Agreements

Required for all members

I have read the San Francisco Fog R.F.C.'s Code of Conduct and agree to abide by its guidelines, conditions and spirit.*

No

Yes

I have read the San Francisco Fog RFC's Member Assumption of Risk and Waiver of Liability, and agree to the terms and conditions included therein.*

No

Yes

If registering as a player, I will complete the required Confidential Medical Information and Health Insurance form to be accessed by authorized medical personnel in the event of an emergency for which immediate care is required.*

No

Yes

I have read and signed the Photo Release Consent Form.*

No

Yes

Payment options

Full membership (Sep 1, 2007-Aug 31, 2008)

$225.00

	Pay $225 via PayPal (You will be prompted to pay on the next screen)
	Pay $225 by check, payable to SF Fog Rugby Football Club
	Pay $225 in three (3) installments of $75 each by check, payable to SF Fog Rugby Football Club
	Due to personal circumstances, I wish to be considered for the Fog Bursary financial assistance program (players only)