Patron in Chief – The Governor- of the Commonwealth of , His Excellency General David Hurley AC, DSC (Retd) Honorary Patron: General the Honourable Sir , AK, MC (Retd) Honorary Patron: Air Chief Marshal Sir Allan Grant “Angus” Houston, AK, AFC (Retd) Honorary Patron: Vice Admiral , AO, CSC RAN (Retd) Patron: General John (JJ) Frewen, DSC, AM

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ACT VETERANS RUGBY MEMBERSHIP REGISTRATION FORM 2020 (Please complete, sign and return to the address at the bottom of the page or email to [email protected] )

Current Details

Family Name

Given Name

Contact Address line 1 ………………………………….. Address Address line 2 …………………………………..

Suburb …………………………………………..

State ……………………………………………. Post Code ………………………………………

Home/ Work Phone

Mobile Phone

Next of Kin Contact Details

Preferred Email Contact

Secondary Email Contact if applicable

Date of Birth

Level of Full ($150)……………. Casual ($30 /game)……….…. Social Membership ($30)

(2020 season) (game by game) (non- playing) (please indicate which membership)

Registration with the ACT Veterans Rugby includes limited insurance coverage (please refer to the Over 35’s Rugby Insurance Program Quick Guide published on the ACT Veterans web page). All playing members are encouraged to ensure that they have adequate personal injury insurance and / or private health insurance coverage.

We strive to provide all new (and existing) members with a Club Registration Number & Club Card. If you have not been issued with any of the above please

ABN 71 779 560 852 ● 10 Jeanette Place Gilmore ACT 2905 ● www.actvetsrugby.org.au When Too Much Rugby is Never Enough! Patron in Chief – The Governor-General of the Commonwealth of Australia, His Excellency General the Honourable David Hurley AC, DSC (Retd) Honorary Patron: General the Honourable Sir Peter Cosgrove, AK, MC (Retd) Honorary Patron: Air Chief Marshal Sir Allan Grant “Angus” Houston, AK, AFC (Retd) Honorary Patron: Vice Admiral Ray Griggs, AO, CSC RAN (Retd) Patron: Lieutenant General John (JJ) Frewen, DSC, AM

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MAJOR SPONSOR enquire and we will sort this out. Membership also entitles each member to a club training t-shirt/singlet (one of – your choice) which we will strive to renew every 2 to 3 years. Additional t-shirts/singlets may be purchased (enquire).

Membership fees: Players’ membership fees are as follows:

Full $150.00 per/year Casual $30.00 per/game Membership Membership

Note: Casual games fees will be capped to $150.00 per annum

Social Membership $30 (Applicable to non-playing members only – ALL players must register for Full or Casual Membership)

Membership fees can be paid in cash/chq/EFT. Payment by cash or cheque can be made to either the Treasurer or the Secretary. Cheques are to be made out to ACT Veterans Rugby Union Club. Those who wish to pay by EFT the details are as follows:

Bendigo Bank / ACT Veterans Rugby BSB: 633-000 Account No: 139753073 Reference: Surname, First Name

All casual membership payments are to be paid to the Treasurer or Registrar on the match day and must be paid before the game (receipts will only be issued on request) otherwise you will not be covered by our insurance.

DISCLAIMER

I ______(the Undersigned), in consideration of ACT Veterans Rugby agreeing to accept and register me as a player for the 2020 season, hereby undertake to be bound by the Laws of the Game of Rugby Football and the rules and regulations of ACT Veterans Rugby, to pay all subscriptions and fees, and, to the extent permitted by Law, and notwithstanding any ineligibility, I hereby waive all claims for liability against any participant and release every participant from all liability, provided that such liability arises while I am participating in any football activity. I agree that ACT Veterans Rugby will hold the benefit of this release and waiver on trust for all participants. For the purpose of this release and waiver:- “the Game” shall mean the game of Rugby Football, which for the purpose of this release and waiver shall include Veterans Rugby, Golden Oldies Rugby and Masters Rugby, or any other form of Rugby Football organised for participation by players over 35 years of age; “participants” shall mean ACT Veterans Rugby and any other rugby union, rugby club or referees’ association in Australia and any member, , official, administrator, executive, coach, manager, selector, referee, touch judge, physiotherapist, trainer, ball boy or girl or unqualified first aid officer associated with such body; “liability” shall mean liability in tort or contract for any death, personal

injury or damage to property including vicarious liability for assault but excluding other liability for assault; “football activity” shall mean playing the Game or engaging in training for the Game or in other sporting or physical or associated travel or other activities as directed or recommended by a participant.

Player signature ______Date ______

ABN 71 779 560 852 ● 10 Jeanette Place Gilmore ACT 2905 ● www.actvetsrugby.org.au When Too Much Rugby is Never Enough!