Name *

Use your real name... There's a field for nicknames below.

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Emergency Contact Phone *

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Team Affiliation

Which teams do you play for? Select all that apply.

Anchors

Sirens

Rusty Anchors

Whitefish

College Training

Youth

Social

I have read, understand and agree to abide by the South Shore Rugby Member Agreement. *

I Agree