2017 Middlesex Rugby 30 Year Award

Please use this form to nominate a member of your club who has given 30 years or more service to the club. You may nominate more than one person from your club, but will need to submit separate forms for each nomination. Awards will be presented at the Middlesex Rugby Volunteer Appreciation Event in conjunction with the RFU Mitsubishi Volunteer Awards at Twickenham Stadium on Friday 9th June.

Closing date for nominations is Friday 19th May 2017.

    Nominee details

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    Your Details

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    Middlesex Rugby

    PK1, Twyford Avenue Sports Ground, Twyford Avenue, Acton, London W3 9AQ T: 020 8896 3400 Email: countyoffice@middlesexrugby.com www.middlesexrugby.com Middlesex Rugby will not pass on or share any information submitted via this form with any third parties.