Midwest Player Transfer Form
* Required
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
CIPP Number
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Reason for Transfer
*
Your answer
Previous Club
*
Your answer
Previous Club Division
*
Choose
Senior
Collegiate
Other
New Club
*
Your answer
New Club Division
*
Choose
Senior
Collegiate
Other
Have you received permission from your previous club to transfer?
*
Choose
Yes
No
Do you have any outstanding disciplinary or financial obligations with your previous club?
*
Choose
Yes
No
Have you competed in league or playoff matches with your previous club in the current membership year’s competitive season?
*
Choose
Yes
No
Have you submitted this transfer request through the USA Rugby website?
*
Choose
Yes
No
Is there any additional information you would like to provide for consideration regarding this transfer?
*
Your answer
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