The Vientiane Buffalos RUFC :: Online Registration

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Online Membership Registration & Payment.

Thank you for considering our club membership, it is from to your kind support that our club is able to continue to promote the good game of rugby in Laos.

Please follow these simple instructions to submit your membership registration information:

1. Fill out the registration form below making sure you fill in all the fields.

2. Be sure to enter the correct amounts in the donations boxes if applicable.

Please Note - no money will be charged to your card at this stage. Payment details will be sent to you once the membership application is accepted.

3. Check the terms and conditions box to enable the submit button. Your registration will be processed followed by a confimation e-mail and full payment details.

Registration Form:

First Name:

Last Name:

Gender:

Male Female

Date of Birth (dd / mm / yyyy)

Nationality:

Occupation:

Postal Address 1:

Postal Address 2:

Postal Address 3:

Postal Address 4:

Country:

E-mail address

Emergency Contact Name:

Emergency Contact No:

(include area code)

Do you have any medical conditions / Allergies

Yes No

If you have checked the yes button,

please give details here.

Shirt Size:

S M L XL XXL

Select the membership you require below.

Full Player Membership (US$100)
Supporters Membership (US$20)
Old Boys Membership (by donation)		Donation amount US$

Additional Donation - Thank You!		Donation amount US$

I have read and agree to the terms and Conditions