Alexandria Rugby Home
Prospective Player Registration Mayor's Cup Home
Full Name:
Address:
Address:
City:
State: Zip Code:
Home Phone:    
Work Phone:
Cell Phone:
E-mail Address:
USA Rugby CIPP No.:  
Date of Birth: (mm/dd/yy):  Age:
Height:        Weight:  
Position: Total Years Played:
Specialty: Total Years Played:
Current Club:
Club President:
President's Phone Number: 
Additional References and Comments to help us know you better:

 

 
 
 
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P.O. Box 26244| Alexandria, VA | 22313