Please use this form ONLY if you are (a) did not register with a WRL club or via this portal in 2021, or (b) are switching clubs for 2022. If you are re-registering with your current club, please don’t fill in this form, instead please contact your club administrator.

First Names *

Surname *

Street Address *

Apartment, suite, etc

City

County

Postal Code

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Date of Birth *

Birthplace *

Email Address *

Phone Number *

Club Registering for *Please select an optionAber Valley WolvesAberavon Fighting IrishBangor BuffaloesBlack DragonsBridgend Blue BullsCambrian CrusadersCardiff Blue DragonsConwy CeltsCynon Valley CavaliersFlintshire FalconsGwendraeth Valley Raiders Marchogion KnightsNewport TitansNorth Wales BuccaneersNorth Wales CrusadersPontyclun KingsRhondda OutlawsSwansea RamsTorfaen TigersValley CougarsWest Wales RaidersWrexham Crusaders communityNorth Wales Origin

Team Type Registering for *Please select an optionMenWomenWheelchairU18 boysU16 boysU16 girlsU14 boysU12 boysU10 boysU8Masters

Last year's club and age group (if applicable) *

Preferred Playing Position *Preferred Playing PositionFull-backWingCentreInside CentreHalf-backUtility BackPropHookerSecond RowBack RowLoose ForwardUtility ForwardCoachOther Club Volunteer

For Wheelchair or PDRL registration only (or please leave as able body)Able BodyDisabledLimited Movement

Player profile picture *

Choose FileNo file chosenDelete uploaded file

Please upload a profile picture of yourself, preferably in the shirt or leisurewear of your registered club. It is preferred that the name of the file uploaded is the name of the player and club.

GDPR *

Yes, I agree with privacy policy, terms and conditions.

GDPR notice can be seen here. Please email the address on the link before submitting the form with any queries if needed.

Parent / Guardian name (if you are under 18)

Relationship (e.g. mother, father etc)

Parent / Guardian Phone (if you are under 18)

Parent / Guardian Email Address (if you are under 18)

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