Expression of interest to play Devon ladies representative rugby 2017

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* 1. What is your full name?

First name

Surname

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* 2. What club are you registered with?

Plymouth Albion

Topsham

Cullumpton

Bideford

Newton Abbot

Plymstock Albion Oaks

Withycombe

Paignton

Honiton

North Tawton

University of Exeter

With Plymouth University

Marjon University

Other (please specify)

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* 3. What are your contact details?

Mobile phone number:

Email:

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* 4. Have you played for Devon ladies before?

Yes

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* 5. Will you be attending the trials? (You are encouraged to make both events)

I will be attending 14/01/2016

I will be attending 28/01/2016

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* 6. What is your date of birth?

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* 7. What is your preferred position? (Please choose just one option)

Loose Head Prop

Hooker

Tight Head Prop

Second Row

Flanker

Number 8

Scrum Half

Fly Half

Inside Centre

Outside Centre

Wing

Full Back

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* 8. What other positions do you like to play? (You can select more than one option)

Loose Head Prop

Hooker

Tight Head Prop

Second Row

Flanker

Number 8

Scrum Half

Fly Half

Inside Centre

Outside Centre

Wing

Full Back

Expression of interest to play Devon ladies representative rugby 2017

Question Title

* 1. What is your full name?

Question Title

* 2. What club are you registered with?

Question Title

* 3. What are your contact details?

Question Title

* 4. Have you played for Devon ladies before?

Question Title

* 5. Will you be attending the trials? (You are encouraged to make both events)

Question Title

* 6. What is your date of birth?

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* 7. What is your preferred position? (Please choose just one option)

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* 8. What other positions do you like to play? (You can select more than one option)

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* 9. Do you have any allergies or medical issues we should be aware of? (ie asthma/diabetes/allergies)

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* 10. If you have any allergies or medical issues, please comment what you do to control/treat?