APPLICATION FOR AUDIENCE MEMBERSHIP

I wish to apply for membership

I wish to renew my membership (Please delete as necessary)

I enclose remittance as follows (Please tick below)

Yearly Membership to 1 August 2008   £10.00 o

5 yearly membership to 1 August 2012  £40.00   o

(If you would prefer to renew membership by Bankers Order, please complete form below.)

Name (Mr/Mrs/Miss/Ms) Please print ...............................................................................

Address........................................................................................................................................

.....................................................................................................................................................

Postcode..........................Telephone:............................E-mail....................................

Signed...................................................................................................Date.................................

Please return this form to the Membership Secretary, Medway Little Theatre, 256 High St, Rochester, Kent ME1 1HY, enclosing a stamped addressed envelope.

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BANKER'S ORDER FORM

If you wish to pay by Banker's Order, please complete the form below and return it with your application to the Membership Secretary. Please do not send this form to your bank.

To the Manager..........................................................................................(Your.bank)

Branch address......................................................................................................

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Bank Sort Code oo-oo-oo Account No.oooooooo

Please pay to the NatWest Bank plc, High Street, Strood, Code No. 60-21-02 to the credit of Medway Little Theatre Ltd, Account No. 56817312, my subscription of £10.00 now and annually on 1st August until further notice.

Signed.....................................................................................Date................................................