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* 1. Name

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* 2. School Name

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* 3. Type of School/Rugby Programme

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* 4. Role 

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* 5. Email

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* 6. Phone

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* 7. Tick box - I confirm that I give permission for St Mary’s University to contact me regarding the RUCKAS HEADCASE study. Your details will not be shared with any other parties and will only be used by the RFU and St Mary’s University for the purposes of this study.

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