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MEMBERSHIP APPLICATION

Please print this page and complete and send it with your payment to:
Shaftesbury Arts Centre, 13 Bell Street, Shaftesbury, Dorset, SP7 8AR.
Names to be entered on Membership Cards:

1. _______________________________________

2. _______________________________________

3. _______________________________________

4. _______________________________________
 
Please tick the type of membership for which you are applying:

1: Individual Membership £22.00
2: Joint Membership £40.00
(two adults at same address)
3: Junior Membership £5.50
4: Individual Membership, reduced £11.00
5: Joint Membership (2), reduced £20.00

Film Society
(Includes full membership of the Arts Centre)
6: Individual Membership, Film £38.00
7: Joint Membership (2), Film £70.00
Reduced rate
8: Individual Membership, Film reduced £19.00
9: Joint Membership (2), Film reduced £35.00

Alternatively you can download an Acrobat PDF file which contains everything needed for a Membership Application

 Address:__________________________________

_________________________________________

_________________________________________

_________________________________________

Post: Code: ___________

Telephone No: _____________________________

Date of birth (Junior Membership) _____________

Email: ___________________________________

Payment enclosed: £________________________

Signature: ________________________________

Date: ____________________________________

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