---

Personal Information
Your First Name:
Your Last Name:
Your Address:
Your Email:
Your Phone:
Your CIPP#:
Other Data
Height:
Weight:
Current Team:
How long with current team (seasons)?
Positions
Please list your position(s) and years experience at each.
Position 1:		Center Fly Half Full Back Hooker Number Eight Prop Scrum Half Second Row Wing Wing Forward -none-
Years Experience:
---------------------------		------------------------------------------------------
Position 2:		Center Fly Half Full Back Hooker Number Eight Prop Scrum Half Second Row Wing Wing Forward -none-
Years Experience:
All-Stars
List your previous All Star or Select Side Tryouts and Selections in any Sport.
Athletic Highlights
If you have accurate info, please provide the following:
40 yard time (sec):
100 yard time (sec):
Bleep level:
Strength Training
Do you Strength Train? If so, please provide the following:
Bench Press (lb):
Squat (lb):
Dead lift (lb):
Clean (lb):
Gear Sizes
T-Shirt Size (S, M, L, XL, XXL):
Polo Size (S, M, L, XL, XXL):
Waist Size (inches):
Parent/Guardian Contact Information
In the block below, identify your Parent(s) or Guardians. List their names, telephone numbers and email addresses.

© copyright 2010 Eastern Pennsylvania Rugby Union P.O. Box 393 ::: Exton, PA 19341 Website design, maintenance & hosting | 4x3, LLC