Wales Under 19 Trial Registration

1. Wales Under 19's Trial

This year Wales rugby league will be holding two trials for the up coming campaign. The event will take place in Merthyr RFC (for South) and Deeside (for North). If you wish to take part in this event please can you complete the attached form. If you have any question please contact Peter.tiffin@walesrugbyleague.co.uk

1. Personal Details

Full Name
Date of Birth
How do you qualify (parent, Grandparent etc)
Club you play for
Preferred playing position
Alternate playing position
Your contact number
Your email

2. Parents contact details if under 18

Name
Relationship (mother, Father)
Telephone number
Email address

3. There are two different venues on two different days. please highlight which day you would prefer to attend

	I will be at this venue	I wont be at this venue
March 09th at Merthyr RFC, CF48 1BA at 1000 - 1400	March 09th at Merthyr RFC, CF48 1BA at 1000 - 1400 I will be at this venue	March 09th at Merthyr RFC, CF48 1BA at 1000 - 1400 I wont be at this venue
March 10th at Deeside Leisure centre CH5 1SA 1000 - 1400	March 10th at Deeside Leisure centre CH5 1SA 1000 - 1400 I will be at this venue	March 10th at Deeside Leisure centre CH5 1SA 1000 - 1400 I wont be at this venue