ࡱ> ~ bjbjVV 4^<<,Q :EEEE   $9N  EE "EEE Ԡ !0Q) ) &)  4B NX      Q)          : CANDIDATE APPLICATION FORM REFEREEINGCourse Name:Course Venue:Course Date(s): Full Forename:Known as: (if applicable)Surname:Gender:Date of Birth:Age:Full Postal Address: Postcode:Previous Address: (If changed in the past 5 years)E-mail address (please print clearly as this will be used to confirm course)Contact Telephone Number:Club, School, College or University Name:Referees Society:Course Fee: Entry Level Referees Award 50.00 Young Officials Award 25.00 Mini-Midi Award 45.00 Continuous Referee Development Award 5.00 Payments Please return this form, with a cheque made payable to RFD Ltd. to Lindsay Piper at  HYPERLINK "mailto:LindsayPiper@rfu.com" LindsayPiper@rfu.com or, by hard copy, to Rugby Football Union, Referee Department, Rugby House, Twickenham Stadium, Twickenham TW2 7BA. If you are paying by credit or debit card, please e-mail the application form WITHOUT your card details to Lindsay Piper -  HYPERLINK "mailto:lindsaypiper@rfu.com" lindsaypiper@rfu.com. Once the form has been e-mailed, please telephone Lindsay on 0208 831 6637 to provide your card details. Alternatively, if you provide a telephone number, we will contact you to obtain this information.Course Fee:Payment Type:ChequeMaster CardVisaSwitchMaestroValid From:Expiry Date:Issue Number:Security Code:Card Number: 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 5 working days before the course start date. The course will be closed to new applicants 5 working days prior to its start date. The R.F.U. reserves to right to cancel courses at short notice. Non-Attendance - Your payment will be processed 5 working days before the course start date. If you are unable to attend the course after that date, you will receive no refund; however you will be offered the opportunity to relocate to another course. If you do not notify  HYPERLINK "mailto:LindsayPiper@rfu.com" LindsayPiper@rfu.com of your intention not to attend, you will receive neither a refund nor the opportunity to relocate. Do you consider yourself to have a disability? Ethnicity - I would best describe myself as:NoWhite: BritishAsian & Asian British: IndianPrefer not to sayWhite: IrishAsian & Asian British: BangladeshiSensory impairment White: OtherAsian & Asian British: PakistaniLearning Disability Mixed: White / Black CaribbeanAsian & Asian British: OtherPhysical DisabilityMixed: White / Black AfricanBlack or Black British: Caribbean Mixed: White / AsianBlack or Black British: AfricanMixed: OtherBlack or Black British: OtherPrefer not to sayOther Ethnic GroupData 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. 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