IRFU-F-392 STAGE 2 IRFU Course Code Course Malone RFC Course 14th & 21st October 2018 Gibson Park Sun 14th 09:15 16:45 – Sun 21st 09:30 15:30 Gibson Park Avenue – Cregagh Road Full attendance is required as part of the Belfast accreditation process. BT6 9GL FIRST NAME(S): SURNAME: ADDRESS: POSTCODE: TELEPHONE NUMBERS: HOME MOBILE NEXT OF KIN: RELATIONSHIP CONTACT NO.s 1. 2. E-MAIL: * PRINT CLEARLY * DATE OF BIRTH: COACHING CLUB NAME School NAME INFORMATION LEVEL / AGE OF TEAM COACHING: PREVIOUS COACHING Venue/Branch / Stage Year ACCREDITATION: DO YOU HAVE ANY Please Tick: SPECIAL DIETARY Yes: ☐ Details:_______________________________________ REQUIREMENTS? No: ☐ DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY OR YES ☐ MOBILITY PROBLEMS THAT MAY RESTRICT FULL COURSE NO ☐ PARTICIPATION? (if you prefer, please call us to discuss what adaptations may be required to you maximum possible PREFER NOT TO ANSWER ☐ participation)
IRFU Course Code IRFU-F-392 STAGE 2 Course Malone RFC Gibson Park Gibson Park Avenue Cregagh Road Belfast BT6 9GL Course 14th & 21st October 2018 Sun 14th 09:15 – 16:45 Sun 21st 09:30 – 15:30 Full attendance is required as part of the accreditation process. FIRST NAME(S): SURNAME: ADDRESS: POSTCODE: TELEPHONE NUMBERS: HOME MOBILE NEXT OF KIN: RELATIONSHIP CONTACT NO.s 1. 2. E-MAIL: * PRINT CLEARLY * DATE OF BIRTH: COACHING INFORMATION CLUB NAME School NAME LEVEL / AGE OF TEAM COACHING: PREVIOUS COACHING ACCREDITATION: Venue/Branch / Stage Year DO YOU HAVE ANY SPECIAL DIETARY REQUIREMENTS? Please Tick: Yes: ☐ Details:_______________________________________ No: ☐ DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY OR MOBILITY PROBLEMS THAT MAY RESTRICT FULL COURSE PARTICIPATION? (if you prefer, please call us to discuss what adaptations may be required to you maximum possible participation) YES ☐ NO ☐ PREFER NOT TO ANSWER ☐