American Flag Rugby Program Membership

Complete the form below to register for American Flag Rugby.

Club or Town name for program:

Program nickname i.e. The Dawgs or The Wanderers:

Program affiliation i.e. PAL or Parks and Recreation:

Program website address:

First Name:

Last Name:

Street1:

Street2:

City:

State: , Zip:

Country:

Email:

Home Phone:

Cell Phone:

Work Phone:

Rugby Experience? Yes  No,  Years Played:

Gender: Male  Female

How did you hear about us? Word of mouth Print media Internet search Other

Add Team Roster:

Questions/comments: