Entry Level Referee Award (ELRA)
Candidate Application Form - Individual
Please complete all sections in BLOCK CAPITALS
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First name
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Surname
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Gender
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M/ F
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Date of Birth
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Age
(if 18 or under)
You must be aged at least 14 to attend an ELRA course
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Full Postal Address
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Postcode
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Email Address
(please print clearly as this will be used to confirm course)
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Contact Telephone Number
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Course Details
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Course applied for
Tick one
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ELRA Stages 1 and 2 (£50)
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ELRA Stages 1 and 2 with Mini Midi (£60)
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Mini/Midi only (£40)
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Course date
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Course fee attached
Payable to RFD Ltd.
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£
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Course venue
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Course Confirmation
Please note that submission of this form constitutes confirmation of your place on your chosen course, unless otherwise notified
You will receive joining instructions by e-mail 3 working days before the course start date
Non-Attendance
Your payment will be processed 3 working days before the course start date. If you are unable to attend the course after that date, you will receive no refund
If you notify lindsaypiper@rfu.com prior to 3 working days before the course start date that you are unable to attend, you will be offered the opportunity to relocate to another course or your payment not processed
Payment
Please return this form, with a cheque made payable to RFD Ltd. or credit/debit card details to Lindsay Piper at lindsaypiper@rfu.com or, by hard copy, to Rugby Football Union, Referee Department, Rugby House, Rugby Road, Twickenham TW1 1DS
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Payment Type
(Please indicate)
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Cheque
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Visa
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Mastercard
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Switch
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Maestro
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Card Number
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Valid From
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Expiry Date
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Security No
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Issue No
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Ethnicity
I would describe my ethnic origin as:
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Asian British Bangladeshi
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Indian
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Other white
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Asian British Indian
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Mixed White and Asian
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Pakistani
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Asian British Pakistani
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Mixed White and Black African
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Prefer not to say
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Bangladeshi
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Mixed White and Black Caribbean
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White British
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Black African
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Other
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White European
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Black British
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Other Asian
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White Irish
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Black Caribbean
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Other Black
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White Non European
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Chinese
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Other Mixed Background
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Disability
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Do you consider yourself to have a disability?
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Yes / No
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Referee Society
If you do not belong to a Society, please state the county in which you live
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Data Protection
The RFU will use your personal data (including potentially sensitive data and that of your parents/guardians) for the purpose of your participation in rugby and for regulatory reasons and to send you information by post. To make your choice as to the categories of commercial information you would wish to receive, you should tick or leave blank the relevant box below.
Subject to your election, the RFU may also use such personal data for the following purposes:
- If you do not wish to receive, by electronic mail (including e-mail, SMS or image messages etc), information about tickets, special offers, opportunities, products and services available from RFU companies or RFU subsidiaries, tick here
- If you do not wish to receive, by electronic mail (including e-mail, SMS or image messages etc), information about products and services available from current RFU sponsors, tick here
- If you do wish to receive, by electronic mail (including e-mail, SMS or image messages etc), information about products and services available from any subsidiary or associated company of any RFU sponsor, tick here
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