Midwest Player Transfer Form
First Name *
Last Name *
Date of Birth *
CIPP Number *
Phone Number *
Email Address *
Reason for Transfer *
Previous Club *
Previous Club Division *
New Club *
New Club Division *
Have you received permission from your previous club to transfer? *
Do you have any outstanding disciplinary or financial obligations with your previous club? *
Have you competed in league or playoff matches with your previous club in the current membership year’s competitive season? *
Have you submitted this transfer request through the USA Rugby website? *
Is there any additional information you would like to provide for consideration regarding this transfer? *
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