Team Registration

* Required Fields

User Name *

Password *

Re-Enter Password *

Team Name *

Previous Name

(Only to be completed if you are changing your team name)

League *

Mixed    Mens    Ladies  

Team Captain *

Street Address 1 *

Street Address 2

Parish *

Post Code *

Home Phone

Mobile

Email Address *

Registration fees for 2011 are £150 per team and can be paid by posting a cheque, made payable to 'Guernsey Touch Rugby LBG', or by BACS to the bank account detailed below.

All fees must be paid by 9 September 2011. Cheques may to be sent to: Richard Duchemin, Apartment 1, Castleview, Les Canichers, St Peter Port, GY1 2LS

Bank: Lloyds TSB (Guernsey) Limited
Sort Code: 30-93-73
Account Name: Guernsey Touch Rugby LBG
Account Number: 02531667
Reference: AL - [Team Name]

I hereby declare that I am aware of and agree to abide by the FNB Touch Autumn League Rules and Regulations. I further declare that payment will be made in a prompt and appropriate manner.